Prepared for
MATANUSKA SUSITNA BOROUGH
350 E. DAHLIA AVENUE
PALMER, ALASKA 99645
Mat-Su Borough Primary
Healthcare Plan 2005-2015
JANUARY 2006
INFORMATION INSIGHTS, INC.
212 FRONT STREET, STE. 100
FAIRBANKS, ALASKA 99701
Mat-Su Borough
Primary Healthcare Plan 2005-2015
JANUARY 2006
Ellen Ganley, President and Principal Consultant
Sylvan Robb, Senior Consultant
Nancy Lowe, Project Coordinator
Prepared for
Matanuska Susitna Borough
350 East Dahlia Avenue
Palmer, AK 99645
Prepared by
Information Insights, Inc.
212 Front Street, Suite 100
Fairbanks, Alaska 99701
(907) 450-2450 phone
(907) 450-2470 fax
605 West 2nd Avenue
Anchorage, Alaska 99501
(907) 272-5074 phone
(907) 272-5076 fax
www.infoinsights.com
[email protected]
Table of Contents
Executive Summary ........................................................................................6
Project Overview ..........................................................................................6
Findings ........................................................................................................7
Recommendations.......................................................................................11
Introduction...................................................................................................15
History of the Rural Healthcare Planning Network....................................15
Goal of the Plan ..........................................................................................16
Relationship to State Health Facilities Planning Guidelines ......................16
Data Sources ...............................................................................................16
Organization of the Report .........................................................................16
Description of the Mat-Su Borough ............................................................18
Geographic Description of the Mat-Su Borough........................................18
Demographic and Housing Characteristics of the Mat-Su Borough ..........18
Access to Healthcare By the Population.....................................................20
The Health and Welfare of Residents of the Mat-Su Borough.................25
Population Characteristics ..........................................................................25
Chronic Disease ..........................................................................................26
Health Risks................................................................................................29
Communicable Disease...............................................................................30
Injury...........................................................................................................31
Cause of Death............................................................................................34
Maternal, Child, and Family Health ...........................................................35
Current Providers and Service Utilization in the Mat-Su Borough.........43
Existing Providers.......................................................................................43
Utlilization ..................................................................................................44
Where People Receive Care .......................................................................47
The Model for Healthcare Services .............................................................50
Service Areas for the Mat-Su Borough.......................................................50
Healthcare models.......................................................................................52
Primary Care Projected Demand And Gap in services...............................54
Oral healthcare Projected Demand And Gap in Services ...........................56
Behavioral Healthcare Projected Demand And Gap in Services................56
Emergency Medical Services Projected Demand And Gap in Services.....57
Appendices.....................................................................................................59
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Mat-Su Primary Healthcare Plan 2005-2015
Appendix A: Key Informant Interview Questionnairre..............................59
Appendix B: Data from Key Informant Interviews ....................................60
Appendix C: Data from Household Survey................................................71
Appendix D: Household Survey Questionnairre ......................................111
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List of Tables
Table 1 Service Area Population Projections: 2004 to 2015 ............................................. 7
Table 2 Service Area Population Density and Median Age: 2000 .................................... 8
Table 3 Current Primary Care Providers and Projected Need ........................................... 9
Table 4 Current Dentists and Projected Need.................................................................... 9
Table 5 Current Behavioral Health Providers and Projected Need ................................. 10
Table 6 Population by Age Group: 2000 ......................................................................... 19
Table 7 Population by Ethnicity: 2000 ............................................................................ 19
Table 8 Housing Characteristics: 2000 ............................................................................ 19
Table 9 Education and Poverty: 2000 Census ................................................................. 20
Table 10 Composition of Residents in the Mat-Su Borough, 2000................................. 26
Table 11 Deaths Due to Chronic Disease in the Mat-Su Valley: 1993 ........................... 26
Table 12 Deaths Due to Chronic Disease in the Mat-Su Valley: 2002 ........................... 27
Table 13 Age Adjusted Death Rates for Coronary Heart Disease.................................... 28
Table 14 Age Adjusted Death Rates for Cancer (Per 100,000 Population, 1990-1998) . 28
Table 15 Chronic Disease Reported in the Mat-Su Borough: 1998 Health Status
Telephone Survey ..................................................................................................... 28
Table 16 Behavioral Risks in the Mat-Su Borough: 1996 – 2001 (95% Confidence
Intervals) ................................................................................................................... 29
Table 17 Health Risks Reported in the Mat-Su Borough: 1998 Health Status Telephone
Survey ....................................................................................................................... 29
Table 18 Tobacco Use in the Anchorage/Mat-Su Borough Region 2000-2002 BRFSS . 30
Table 19 Gonorrhea Cases by Borough: 1999................................................................. 30
Table 20 AIDS Cases by Borough of Residence at Diagnosis Data Cumulative as of June
30, 1999..................................................................................................................... 31
Table 21 Deaths Due to Unintentional Injury in the Mat-Su Valley: 1993 ..................... 32
Table 22 Deaths Due to Unintentional Injury in the Mat-Su Valley: 2002 ..................... 32
Table 23 Traumatic Brain Injury: 1996-1998.................................................................. 33
Table 24 Potential Causes of Injury Reported in the Mat-Su Borough: 1998 Health Status
Telephone Survey ..................................................................................................... 33
Table 25 Family Violence Reported in the Mat-Su Borough: 1998 Health Status
Telephone Survey ..................................................................................................... 33
Table 26 Five Leading Causes of Death in the Mat-Su Valley: 1993 ............................. 34
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Table 27 Five Leading Causes of Death in the Mat-Su Valley: 2001 ............................. 34
Table 28 Children in the Mat-Su Borough: 2000 ............................................................ 35
Table 29 Racial Composition of Children (19 and Under) in the Mat-Su Borough, 2000
................................................................................................................................... 35
Table 30 Family Income: 2000 ........................................................................................ 36
Table 31 School Children Ages 5 to 17 Receiving Public Assistance* Selected Districts,
2001-2002 School Year ............................................................................................ 36
Table 32 Percent of Mothers Receiving Less Than Adequate Prenatal Care 5-Year
Average, 1997-2001.................................................................................................. 37
Table 33 Percent of Alaska Babies with Low Birth Weight, by Region 5-Year Average,
1997-2001 ................................................................................................................. 38
Table 34 Birth Rate for Teens by Region Per 1000 Girls, 5-Year Average, 1997-2001. 38
Table 35 School District Enrollment: 1988 and 2004 ..................................................... 39
Table 36 Percentage of Dropouts (Grades 9-12) by Region: 2001-2002 ........................ 39
Table 37 Child and Adolescent Injuries in the Mat-Su Borough: 1994-1998 ................. 40
Table 38 Serious and Fatal Firearm Injuries, Ages 0-19 (Rate/100,000 Youth) 1991-1997
................................................................................................................................... 41
Table 39 Infant Mortality Rate by Region Per 1000 Live Births, 5-Year Average, 19972001........................................................................................................................... 42
Table 40 Child Death Rate by Region Per 100,000 Children (1-14) 5-Year Average,
1997-2001 ................................................................................................................. 42
Table 41 Mat-Su Borough Primary Care Providers......................................................... 44
Table 42 Primary Care Telephone Survey....................................................................... 45
Table 43 Patient Origin by Provider Type....................................................................... 46
Table 44 Provider Practice Characteristics ...................................................................... 47
Table 45 Third Party Payment Sources ........................................................................... 47
Table 46 Location of Primary Care Services Used by Mat-Su Borough Residents ........ 48
Table 47 Reasons for Seeking Primary Care Elsewhere ................................................. 49
Table 48 Primary Care Service Areas.............................................................................. 50
Table 49 Provider to Population Ratios ........................................................................... 54
Table 50 Current Primary Care Providers and Projected Need ....................................... 55
Table 51 Mat-Su Borough Population Projections: 2004 to 2015................................... 55
Table 52 Current Practicing Dentists and Projected Need: 2004 to 2015 ....................... 56
Table 53 Current Behavioral Health Professionals and Projected Need: 2004 to 2015 .. 57
Table 54 EMS Resources by Service Area ...................................................................... 58
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Executive Summary
PROJECT OVERVIEW
Four years ago, a group of rural healthcare providers concerned about primary care
access outside the core area formed the Mat-Su Rural Healthcare Planning Network
(RHPN). Initially, this network offered a forum for increased communication between
rural providers to discuss best practices and to collaborate and plan for primary care
access in underserved areas. Over time, the focus of the effort expanded to include the
entire borough, although the group elected not to change its name. The RHPN included
primary care (with EMS), oral health, and behavioral health services in its planning
efforts.
The goal of the RHPN was to create a comprehensive, holistic, healthcare plan for the
Mat-Su Borough. Having this plan will conserve local resources, while demonstrating the
foresight and collaboration necessary to garner additional funding. Most importantly, this
plan will help meet the healthcare access needs of all borough residents in the best
manner possible.
In order to complete the healthcare plan, providers agreed that more data was required to
properly identify the primary care needs of borough residents and to justify the need for
additional resources. In 2002, the Denali Commission awarded the RHPN (through the
Mat-Su Borough) a grant to conduct a primary care needs assessment and gap analysis of
healthcare for rural Mat-Su Borough residents. A consulting firm, Information Insights,
was hired to complete this work. After some work had been completed, it became clear
that having a borough-wide plan would be preferable. Additional funding was secured
from the Denali Commission to expand the project borough-wide.
Members of the RHPN signed a memorandum of agreement to collaborate on this
project. The official members of the RHPN include Chickaloon Village Traditional
Council, Mat-Su Health Services, Matanuska-Susitna Borough, Southcentral Foundation,
Sunshine Community Health Center, Valley Healthy Communities Program, and Valley
Hospital Association. Other frequent meeting attendees included staff from the Denali
Commission, Mat-Su Public Health, and the Alaska Department of Health and Social
Services. The meetings have always been open to anyone and the group has tried to
reach out to the healthcare community in the Mat-Su Borough. Additionally, there has
always been a public website where all the documents for the project are available. That
website is http://healthnetwork.infoinsights.com. The full text of reports on the data
collection activities are available on the website.
The project has tried to include every recognized community in the borough.
Communities that have been included in project activities are: Big Lake,
Buffalo/Soapstone, Butte, Chase, Chickaloon, Farm Loop, Fishhook, Gateway, Glacier
View, Houston, Knik, Knik River, Lake Louise, Lakes (north and south), Lazy Mountain,
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Meadow Lakes, Palmer, Petersville, Pt. McKenzie, Skwentna, Susitna, Sutton, Talkeetna,
Tanaina, Trapper Creek, Wasilla, Willow and Y.
Data regarding these communities and their current healthcare availability and needs was
collected through a review of existing plans, data and providers, community meetings
held in each community, interviews with 50 key informants in the borough, and a survey
of 400 impacted residents. After the data had been gathered, a needs assessment and gap
analysis of the healthcare availability in these communities was completed. Using the
results of the needs assessment and gap analysis, a thorough, holistic health plan was
developed for the borough. An overview of the major findings follows.
It is important to remember that the data contained in this report, and upon which the plan
was based, is a snapshot. The data were accurate at the time they were collected, but
progress has marched on. The Mat-Su Borough is experiencing such rapid change that
many things have continued to change in the time it took to compile the data and write
this report. Efforts have been made to update materials as much as possible, but readers
are advised to understand that some numbers may have changed since the data was
collected.
FINDINGS
•
The Mat-Su Borough is the fastest growing area of the state. The population
growth rate in Alaska between 2000 and 2004 was 5%, in the Mat-Su Borough it
was 18%.
Table 1 Service Area Population Projections: 2004 to 2015
Service Area
Average Annual
Population Growth
(2000-2004)
Population
2004*
Projected
2010
Projected
2015
Core Area
3.9%
32,336
40,675
49,245
Old Glenn Hwy
2.9%
4,822
5,724
6,604
Knik Goosebay Rd
7.2%
9,439
14,288
20,185
South Parks Hwy
4.3%
10,225
13,128
16,167
Glenn Hwy South
2.5%
2,196
2,542
2,872
Glenn Hwy North
2.1%
365
412
456
Upper Susitna Valley
2.3%
4,250
4,878
5,471
-6.7%
112
74
52
Off Road
*State Demographer Estimate
•
The Mat-Su Borough is very large; it is over 25,000 square miles. It is the fourth
largest geographic area of any county-level government unit in the country. The
area is very diverse.
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Mat-Su Primary Healthcare Plan 2005-2015
Table 2 Service Area Population Density and Median Age: 2000
Service Area
Core Area
8
Population Density
(people per square mile)
Median Age
435.3
31.9
Old Glenn Hwy
38.4
36.3
Knik Goosebay Rd
66.8
33.3
South Parks Hwy
57.3
34.3
Glenn Hwy South
14.8
36.7
Glenn Hwy North
1.3
44.0
Upper Susitna Valley
4.6
40.6
Off Road
0.2
44.6
•
Residents are widely dispersed throughout the borough with a driving distance of
over 240 miles between Trapper Creek and Lake Louise. Some residents live off
the road system entirely.
•
Many residents of the Mat-Su Borough do not have health insurance or are only
covered for catastrophic injuries or illness. Many residents work seasonally or are
self-employed and are not likely to acquire insurance under the current system.
•
The Mat-Su Borough has difficulty trying to recruit locally trained physicians or
dentists because Alaska lacks a medical school or dental school.
•
Residents of the Mat-Su Borough have trouble accessing healthcare for a variety
of reasons: lack of insurance or inability to pay, lack of transportation, and an
inadequate number of providers to meet the demands of a growing population.
•
Healthcare providers in the Mat-Su Borough are remarkably willing to collaborate
with each other.
•
Current EMS volunteers are extremely dedicated, but in many areas of the
borough there are not enough volunteers to provide adequate round-the-clock
coverage.
•
Many residents lack access to prevention-orientated healthcare and are not well
educated about healthy lifestyle choices.
•
Mat-Su Borough residents are likely to obtain healthcare near their place of
employment. Nearly 40% of Mat-Su Borough residents work in Anchorage.
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Mat-Su Primary Healthcare Plan 2005-2015
Table 3 Current Primary Care Providers and Projected Need
Number of
Current
Providers*
Primary Care Physicians Needed
2004
2010
2015
40
16.17
20.34
24.62
Old Glenn Hwy
0
3.21
3.82
4.40
Knik Goosebay Rd
0
6.29
9.53
13.46
South Parks Hwy
0
6.82
8.75
10.78
Glenn Hwy South
0
1.83
2.12
2.39
Glenn Hwy North
0
0.30
0.34
0.38
Upper Susitna Valley
2
3.54
4.07
4.56
Off Road
0
0.09
0.06
0.04
42
38.25
49.03
60.63
Service Area
Core Area
Total
*Includes primary care, pediatricians, OB/GYN, and internists.
•
Residents of the Mat-Su Borough currently find it difficult to access information
about providers and services that are available to them.
•
Most primary care providers are currently located in the core area of the borough.
As other areas of the borough grow, there will be opportunities for providers to
practice or provide services in fast growing service areas such as Knik Goosebay
Road and the South Parks Highway areas. Many areas of the borough either do
not have enough providers currently, or will not in the future assuming the current
rate of population growth continues.
Table 4 Current Dentists and Projected Need
Dentists Needed
Number of
Current Providers
2004
2010
2015
34
16.17
20.34
24.62
Old Glenn Hwy
0
3.21
3.82
4.40
Knik Goosebay Rd
0
6.29
9.53
13.46
South Parks Hwy
0
6.82
8.75
10.78
Glenn Hwy South
0
1.83
2.12
2.39
Glenn Hwy North
0
0.30
0.34
0.38
Upper Susitna Valley
1
3.54
4.07
4.56
Off Road
0
0.09
0.06
0.04
35
38.25
49.03
60.63
Service Area
Core Area
Total
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Table 5 Current Behavioral Health Providers and Projected Need
Behavioral Health Providers Needed
Number of
Current Providers
2004
2010
2015
25
8.98
11.30
13.68
Old Glenn Hwy
0
1.34
1.59
1.83
Knik Goosebay Rd
0
2.62
3.97
5.61
South Parks Hwy
0
2.84
3.65
4.49
Glenn Hwy South
0
0.61
0.71
0.80
Glenn Hwy North
0
0.10
0.11
0.13
Upper Susitna Valley
1
1.18
1.36
1.52
Off Road
0
0.03
0.02
0.01
26
17.70
22.71
28.07
Service Area
Core Area
Total
Notes and assumptions for the tables.
1. The number of current providers reflects the number of actual providers in the area,
not the level of full time equivalents (FTE). Not all current providers are working full
time. Projected need is for FTEs.
2. Projected providers assumes each service area continues to experience the same rate
of population growth for the upcoming ten years as it has for the previous five years
(see page 3 for projected population and growth rates).
3. The level of current and projected providers needed is based on a provider to
population ratio. The ratio used here is that used by Southcentral Foundation since
they are serving clients in Alaska. However their ratios and those used here are
within the ranges deemed reasonable by provider organizations and reflect national
use data. The ratios for primary care providers and dentists were adjusted for
different service areas because providers in rural areas are expected to serve fewer
people. The reality for rural providers is that they spend more time with each patient
since there are fewer support staff.
For the Core Area the ratio for primary care providers and dentists is 1 provider to
2,000 people in the population. For the collar areas of the Old Glenn Highway, Knik
Goosebay Road, and the South Parks Highway, the ratio for primary care providers
and dentists is 1:1,500. For the remaining service areas which are all rural, the ratio
for primary care providers and dentists 1:1,200. The ratio for behavioral health
providers is the same for all service areas (there are no additional tests for behavioral
health providers to run in rural areas that urban providers would have support staff to
administer) at 1:3,600.
One additional consideration when thinking about the required providers for the Mat-Su
Borough is to consider the impact of tourists. For example, the Upper Susitna Valley has
over 400,000 people pass through who visit Denali National Park each summer. Many
tourists drive out the Glenn Highway to Glacier View. Other communities like Lake
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Louise more than double in size in the summer as people come to their summer cabins.
These and other areas in the borough also see sizable numbers of people visiting to snow
machine.
RECOMMENDATIONS
The focus of the Matanuska-Susitna Borough Primary Healthcare Plan is medical, dental
and behavioral healthcare. The plan could not effectively focus on other services such as
services for seniors or those with disabilities. The goal of the plan is that healthcare
services be available to all people in Mat-Su Borough regardless of race/ethnicity, ability
to pay, access to private transportation, or geographic location in the borough. The
following recommendations are made towards reaching that goal.
1. Borough Health and Social Services Task Force
Population growth made the Matanuska-Susitna Borough eligible for the State’s
Health and Human Services Matching Grant program two years ago. The Borough is
currently using the basic health and social services powers it has to administer the
grant. Local providers see the expansion of the Borough’s health and social service
powers as a way to attract additional funding for services, with the Borough acting as
a pass-through for project funding. Before this Task Force is formed, the state’s
Director of Public Health should be consulted. During interviews with key
informants, many people expressed an interest in seeing the merits of this idea being
fully considered.
Recommendation: The Mat-Su Borough should form a Task Force to research and
explore the need for health and social service powers, including the establishment of a
commission or board to advise the Borough Assembly on matters related to health
and social services.
2. Collaboration Between Primary Care Providers
The face of primary care in the Matanuska-Susitna Borough has changed drastically
in the past year. A new hospital will open in January 2006, a Section 330 Community
Health Center* was funded in Wasilla, and the Southcentral Foundation opened a
clinic in Wasilla. Continued growth in population will bring additional changes to the
primary care system.
Recommendation: Primary care providers (medical, dental, and behavioral health
providers as well as the Native, non-Native, and Veterans care systems) are
encouraged to continue their collaboration to ensure that high quality healthcare
services are available to all residents of the Borough, no matter where they live.
*
Section 330 Community Health Centers are federally funded health clinics that offer services on a sliding
fee scale so people are charged according to their ability to pay. A region must demonstrate that there is
unmet need in order to qualify for Section 330 funding.
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Mat-Su Primary Healthcare Plan 2005-2015
Agencies serving Alaska Natives, the Veterans’ Administration, private providers,
and others should work towards sharing providers or facilities as a means of
extending services to all parts of the Borough.
3. Section 330 Community Health Centers
There are currently two Section 330 Community Health Centers* in the MatanuskaSusitna Borough. One is located in Wasilla (Mat-Su Health Services) and the other is
in Talkeetna (Sunshine Community Health Center) with a satellite clinic in Willow.
These clinics provide sliding-fee based primary care services to people living in the
heavily populated southern portion of the Borough and to the residents of
communities along the Parks Highway. There are few primary care options available
to those living in the eastern portion of the Borough along the Glenn Highway.
Recommendation: The Mat-Su Borough and the Rural Healthcare Planning Network
should support the development and funding of a new or satellite Section 330
Community Health Center to serve the residents of the Glenn Highway North and
South service areas as appropriate for the population.
Current facility needs for Community Health Centers include an expansion of the
Sunshine Community Health Center to accommodate its designation as a Frontier
Extended Stay Center, where patients needing limited observation can stay rather than
going to the hospital in Wasilla. A facility to house a Community Health Center
(either a new program or satellite of an existing center) in the Glenn Highway North
or South service areas will be needed within the next five years. The Community
Health Centers are encouraged to explore the possibility of contracting with local
providers before expanding their existing facilities.
4. Transportation Coordination
Many low income residents of the Borough, especially those living in outlying areas,
have difficulty finding reliable transportation to get to primary care appointments or
other important destinations.
Recommendation: The MASCOT program is encouraged to continue to work with
health and human services providers to create a regional transportation system that
utilizes existing vehicles (owned by the health and human service providers) and is
coordinated through a central dispatch. This system would provide more frequent
service and cover a greater portion of the Borough.
*
Section 330 Community Health Centers are federally funded health clinics that offer services on a sliding
fee scale so people are charged according to their ability to pay. A region must demonstrate that there is
unmet need in order to qualify for Section 330 funding.
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5. Emergency Medical Services
The availability of emergency medical services is limited in many of the Borough’s
outlying communities. The level of training and expertise for EMS providers varies
from community to community.
The Borough’s EMS system currently has no full-time employees. It is very difficult
to train and maintain “volunteer” EMS personnel and expect to develop the
experience and knowledge level equal to a paid, full-time workforce. The higher level
training and certification requires a greater time commitment from our volunteer
personnel; a commitment which most of them cannot make.
Recommendation: The Mat-Su Borough should review its EMS protocols to identify
gaps in service availability and coverage. The Mat-Su Borough should establish
population criteria for the level of service that will be available in each community
with an emphasis on providing more highly trained personnel in areas where medical
services are limited or not available.
6. Healthcare Workforce
Nationally, there are shortages of doctors, nurses, dentists, dental hygienists, and
counselors. Recruitment is even more difficult in Alaska where there are no medical
or dental schools from which to draw new doctors and dentists. The state’s winter
weather and darkness can also be a deterrent to recruiting providers from other states.
Recommendation: Mat-Su Resource Conservation and Development, the Mat-Su
Regional Advisory Council, the Mat-Su Borough School District, Southcentral
Foundation, the University of Alaska Mat-Su College, Job Corp, and other agencies
are encouraged to address staffing sustainability for healthcare (primary care,
behavioral healthcare, oral healthcare, and associated allied health professionals) in
the Mat-Su Borough through dialogue and collaboration. These groups should work
to more effectively utilize the Alaska Family Practice Residency Center and ANP/PA
mentorships the University of Alaska already operates.
7. Preventive Healthcare
Exercise, good nutrition, and regular checkups have been proven to prevent or delay
the onset of many medical, dental and behavioral health problems.
Recommendation: All areas without a resident healthcare provider should have an
annual health fair as well as other preventative health measures (such as a community
treadmill, etc.) which are tailored to meet the specific needs of a community. These
activities should be undertaken through a collaboration between the Mat-Su Public
Health Service, Valley Healthy Communities Program, Alaska Health Fair, Inc., the
Cooperative Extension Service, the Mat-Su Borough School District, the United Way
of Mat-Su, and existing service providers.
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8. Access to Provider and Service Information
Many Borough residents, especially seniors, said that they had difficulty determining
what services were available and which providers accept Medicaid or Medicare.
Recommendation: The United Way of Mat-Su and other partners are encouraged to
continue their efforts to implement the 211 telephone and website clearinghouse for
health and social services. The United Way is encouraged to compile and maintain a
website of providers who are currently accepting new Medicare, Medicaid, and
Denali Kid Care patients.
9. Veterans’ Healthcare Services
Nearly a fifth (19.4%) of the residents of the Matanuska-Susitna Borough are military
veterans. Most veterans who live in the Borough must go to Anchorage in order to
receive Veterans’ Administration funded healthcare services.
Recommendation: The Veterans’ Administration should expand its contracting for
healthcare services in the Mat-Su Borough so that veterans can receive services in
their community. The VA is encouraged to utilize existing services within the MatSu community whenever possible.
10. Disaster Preparedness
Many groups in the Mat-Su Borough are working to improve disaster preparations
and hold drills to ensure readiness and training.
Recommendation: The Mat-Su Borough should continue work to improve
coordination among local, state, and federal agencies and any potential community
resources regarding disaster preparedness efforts.
11. Healthcare Facilities
While the vast majority of the Mat-Su Borough’s population lives within a reasonable
distance of the Core Area and the services it provides, healthcare must be available to
those who live further away. Communities in the outer reaches of the Borough are
too small to each support their own facilities, so services should be provided in hub
communities.
Recommendation: All providers are encouraged to use this plan to inform and justify
service expansion. Whenever possible, providers should expand existing facilities
and infrastructure and ensure that any planned facilities are sustainable before
expanding or building new facilities.
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Introduction
HISTORY OF THE RURAL HEALTHCARE PLANNING NETWORK
Four years ago, a group of rural healthcare providers concerned about primary care
access outside the core area formed the Mat-Su Rural Healthcare Planning Network
(RHPN). Initially, this network offered a forum for increased communication between
rural providers to discuss best practices and to collaborate and plan for primary care
access in underserved areas. Over time, the focus of the effort expanded to include the
entire borough, although the group elected not to change its name. The RHPN included
primary care (with EMS), oral health, and behavioral health services in its planning
efforts.
Members of the RHPN signed a memorandum of agreement to collaborate on this
project. The official members of the RHPN include Chickaloon Village Traditional
Council, Mat-Su Health Services, Matanuska-Susitna Borough, Southcentral Foundation,
Sunshine Community Health Center, Valley Healthy Communities Program, and Valley
Hospital Association. Other frequent meeting attendees include staff from the Denali
Commission, Mat-Su Public Health, and the Alaska Department of Health and Social
Services. The meetings have always been open to anyone and the group has tried to
reach out to the healthcare community in the Mat-Su Borough. Additionally, there has
always been a public website where all the documents for the project are available.
The project has tried to include every recognized community in the borough.
Communities that have been included in project activities are: Big Lake,
Buffalo/Soapstone, Butte, Chase, Chickaloon, Farm Loop, Fishhook, Gateway, Glacier
View, Houston, Knik, Knik River, Lake Louise, Lakes (north and south), Lazy Mountain,
Meadow Lakes, Palmer, Petersville, Pt. McKenzie, Skwentna, Susitna, Sutton, Talkeetna,
Tanaina, Trapper Creek, Wasilla, Willow and Y. There are additional people living in
the Mat-Su Borough who do not reside in a community, but they are so scattered it was
impractical to attempt to get their input beyond their potential inclusion in the community
survey.
In order to complete the healthcare plan, providers agreed that more data was required to
properly identify the primary care needs of borough residents and to justify the need for
additional resources. In 2002, the Denali Commission awarded the RHPN (through the
Mat-Su Borough) a grant to conduct a primary care needs assessment and gap analysis of
healthcare for rural Mat-Su Borough residents. A consulting firm, Information Insights,
was hired to complete this work. After some work had been completed, it became clear
that having a borough-wide plan would be preferable. Additional funding was secured
from the Denali Commission to expand the project borough-wide.
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GOAL OF THE PLAN
The goal of the RHPN was to create a comprehensive, holistic, healthcare plan for the
Mat-Su Borough. Having this plan will conserve local resources, while demonstrating the
foresight and collaboration necessary to garner additional funding. Most importantly, this
plan will help meet the healthcare access needs of all borough residents in the best
manner possible. The group agreed the plan could not and should not try to address
every health and social service problem in the borough. The plan focuses on primary
medical care (including EMS), oral health, and behavioral health services.
RELATIONSHIP TO STATE HEALTH FACILITIES PLANNING GUIDELINES
In 1999, the Denali Commission was granted authority by Congress to address rural
Alaska health care issues. Among other functions, this authority authorized the Denali
Commission to support community planning as a means of identifying primary care
facility needs. The Denali Commission provided funding to the Matanuska-Susitna
Borough to support the activities of the RHPN and the development of this plan.
DATA SOURCES
Data regarding these communities and their current healthcare availability and needs was
collected through a review of existing plans, data and providers, community meetings
held in each community, interviews with 50 key informants in the borough, and a survey
of 400 impacted residents. After the data had been gathered, a needs assessment and gap
analysis of the healthcare availability in these communities was completed. Using the
results of the needs assessment and gap analysis, a thorough, holistic health plan was
developed for the borough.
ORGANIZATION OF THE REPORT
The next chapter of this report contains information about the Mat-Su Borough. It
provides the lay of the land as well as demographic information about residents. The
following chapter has information about the current health of Mat-Su Borough residents.
The following chapter contains information on current providers in the Mat-Su Borough.
The next chapter highlights how projections were made and the need for services now
and in the future. The final three chapters contain the findings, the barriers to
implementing the recommendations, and the recommendations. There are appendices
with more information about the data collection activities.
It is important to remember that the data contained in this report, and upon which the plan
was based, is a snapshot. The data was accurate at the time they were collected, but
progress has marched on. The Mat-Su Borough is experiencing such rapid change that
many things have continued to change in the time it took to compile the data and write
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this report. Efforts have been made to update materials as much as possible, but readers
are advised to understand that some numbers may have changed since the data was
collected.
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Description of the Mat-Su Borough
GEOGRAPHIC DESCRIPTION OF THE MAT-SU BOROUGH
The Matanuska-Susitna Borough is situated within the heart of Southcentral Alaska,
encompassing more than 25,000 square miles (about the size of the state of West
Virginia). It is the fourth largest geographic area of any county-level government unit in
the country. The area is very diverse. The Mat-Su Borough had an average of 2.4 people
per square mile, although this varies widely. In the core area of Palmer and Wasilla the
population density is 435 people per square mile, while in the roadless areas the density is
0.2 people per square mile. Alaska averages 1.1 person per square mile. Residents are
widely dispersed throughout the borough with a driving distance of over 240 miles
between Trapper Creek and Lake Louise. Some residents live off the road system
entirely.
The borough includes mountain ranges and valleys; glaciers, rivers, and lakes; wetlands,
tundra, and boreal forest; farms, towns, suburban homes, and isolated cabins; and vast
stretches of pristine wilderness. The borough includes portions of the Alaska Range with
the tallest mountain in North America, Mount McKinley, just outside its northern
borders; portions of the Chugach Mountains to the south; and virtually the entire
Talkeetna and Clearwater Ranges in its interior.
DEMOGRAPHIC AND HOUSING CHARACTERISTICS OF THE MAT-SU BOROUGH
The Mat-Su Borough is the fastest growing area of Alaska. The estimated population of
the Mat-Su Borough in 2004 was 72,278. The population in 2000 was 59,322. The
percent change in population between April 1, 2000 and July 1, 2004 was 21.8%.
Alaska’s statewide population grew by 4.5% during that same time period. Even with
this high rate of population growth in the Mat-Su Borough, the rate is slowing (as is the
statewide rate). Between 1990 and 2000 the population growth rate in the Mat-Su
Borough was 49.5%. Alaska’s population grew by 14.0% during the same time.
As indicated in the table below, the Mat-Su Borough was very similar to the state with
regard to the percentage of children 5 years old or younger, the percentage of children 18
years old or younger, the percentage of residents over 65 years old, and the percentage of
the population that is female. The median age varies throughout the borough with
younger people tending to live in the Palmer-Wasilla area and older people living in the
rural areas. In the Palmer-Wasilla area the median age is 31.9 year old, while in the
roadless areas the median age is 44.6 years old.
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Table 6 Population by Age Group: 2000
% of residents…
Mat-Su Borough
Alaska
5 years old or younger
7.0%
7.6%
18 years old or younger
32.2%
30.4%
65 years old or older
5.9%
5.7%
Female
48.0%
48.3%
The Mat-Su Borough has substantially more white residents than Alaska does statewide.
The borough also has only about one third as many Alaska Native residents as the state
does overall.
Table 7 Population by Ethnicity: 2000
% of residents…
Mat-Su Borough
Alaska
White
87.6%
69.3%
Alaska Native /American Indian
5.5%
15.6%
Reporting more than 1 race
4.6%
5.4%
Other races (Black, Asian, Native
Hawaiian, Pacific Islander)
2.4%
9.6%
Part of the reason the Mat-Su Borough has experienced such high rates of population
growth in recent years is that the area offers lower housing costs relative to Anchorage,
yet is close enough that workers can commute to Anchorage. Given its high rate of
population growth, it is surprising that the borough actually has a higher percentage of
residents living in the same house in 2000 as 1995 compared to the state. In 2002 the
Mat-Su Borough had 27,485 housing units, and 20,556 households. The borough had
only a slightly higher number of people per household relative to the state. A greater
than average number of the housing units were single-family homes and in 2000 the MatSu Borough outpaced the state in homeownership rates by over 16 percentage points.
Workers are paying for their housing deals with time—the Mat-Su Borough workers had
a commute time that is more than double the average state commute.
Table 8 Housing Characteristics: 2000
Housing Characteristics
Mat-Su Borough
Alaska
Homeownership rate
78.9%
62.5%
People per household
2.84
2.74
49.4%
46.2%
9.9%
27.0%
$125,800
$144,200
40.7
19.6
Living in same house in 1995 and 2000', pct age 5+,
Housing units in multi-unit structures, percent
Median value of owner-occupied housing units
Mean travel time to work (minutes), workers age 16+
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The Mat-Su Borough is very similar to the state in the percentage of residents with a high
school diploma, but the borough had a lower percentage of residents with a college
degree. The median household income in the borough was nearly identical to the state’s
median household income. The borough had a higher percentage of residents living in
poverty than the state. The Mat-Su Borough had about half as many foreign born
residents as the state and, not surprisingly, also had fewer households where English was
not the language spoken in the home.
Table 9 Education and Poverty: 2000 Census
Education and Poverty
Mat-Su Borough
Alaska
High school graduates, people age 25+
88.1%
88.3%
Bachelor's degree or higher, people age 25+
18.3%
24.7%
$51,221
$51,571
11.0%
9.4%
Foreign born persons
2.6%
5.9%
Language other than English spoken at home, age 5+
5.1%
14.3%
Median household income
Persons below poverty
ACCESS TO HEALTHCARE BY THE POPULATION
Asking people about their access to healthcare was the overriding theme of the data
collection efforts. At the community forums held in each community residents were
asked about their access to healthcare and what prevented them from having access if it
was an issue for them. What was learned from the community forums is that there are
two primary barriers to accessing health care: cost and transportation. Residents were
asked similar questions on the household survey. Key informants were also asked about
these issues.
Cost as a barrier
Many, many residents at the community forums said they did not have regular access to
medical care. People stated that cost was a decision making factor when considering
whether to seek emergency treatment in situations that did not seem immediately lifethreatening. At least two people were seen at community forums who clearly needed
medical care. For example, one woman was limping and said she had been told she
needed a knee replacement. She did not have insurance, and did not qualify for Medicaid
because she owned a small piece of property. She had no immediate plans to seek
treatment for her knee problem.
While the answers to these questions about barrier to access were not surprising, the
consistence and urgency with which people said they could not afford healthcare was
stunning. Of course people without insurance who do not live near one of the
Community Health Centers (located in Talkeetna and Wasilla) which offer service on a
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sliding fee scale have the worst plight. In many of the rural communities in the borough,
a substantial portion of the population does not have insurance. Many people are self or
seasonally employed. Some of the more remote communities do not have any large
employers aside from the government, so nearly everyone is without insurance. Even
people with insurance are feeling the pinch. More costs are passed on to the consumer
and people are worried about paying their medical bills. Many residents, both with and
without insurance, said they do not go to the doctor unless it seemed serious.
As part of the data collection, a household survey of 400 borough residents was
conducted. The vast majority of respondents—84%--indicated that they have some type
of health coverage. Over 65% said they have private insurance coverage. Among those
without insurance, the most common reason given for not having insurance was an
inability to afford it. The high level of self-reported medical insurance coverage must be
viewed through the lens of a telephone survey and the bias that introduces into a sample.
Immediately the sample is slightly biased because only households with a telephone were
contacted. Those too poor to have a telephone were excluded. Additionally, the survey
did not include those people who have registered with the national “No Call” list. Cell
phones were not included in the sample, and many of those who only have a cell phone
are younger people who are less likely to have a job where health coverage is available.
Among the respondents who said they had private insurance, 4.8% of those reported that
their coverage was only catastrophic or major medical type coverage. The next most
common type of coverage was Medicare with just 7.8% of reporting that coverage. The
survey sample divided the borough into four regions, the two rural regions were much
less likely to report having private health insurance. Only 13.5% of respondents
answered the question about why they did not have health insurance. The most common
answer was an inability to afford it, which was cited by 35 of the 54 people answering.
Other answers included not wanting insurance which 7 people reported or other reasons
reported by 8 people.
People’s inability to afford the health care they need was the number one access issue
raised by the key informants. It was the most frequently mentioned barrier to access and
the top answer when people were asked to name the biggest health care issue.
Respondents did not hesitate. Some people were saying, “Cost” in answer to the question
before the question was even finished. The only group of respondents for which cost was
not the dominant answer was providers.
Opinions among the key informants were about evenly split as to whether this issue was
more pressing in either the urban or rural areas of the borough. About half of
respondents felt that the issue was the same across all areas of the borough (with many
respondents noting that the issue is the same across the country). The other half of
respondents felt that the lack of insurance and inability to pay was a bigger issue in the
rural areas of the borough. Many people felt that the jobs available in those areas were
much less likely to offer insurance than jobs in the more urban areas of the borough.
Transportation as a barrier
The other consistent barrier to healthcare access is transportation. While the distance of
transportation needed is more of an issue in the rural communities, transportation was an
issue mentioned everywhere. This barrier was not expressed as strongly in the
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community forums as the cost issue, but to some degree there was a selection bias—
everyone who came to a community forum obviously had some means of transportation.
Many residents at the community forums mentioned that they had older relatives or
neighbors who had trouble getting around.
Since there is very little public transportation, unless you have a vehicle and driver’s
license, or very kind friends or family, there is no way to get places. Currently
MASCOT, the public transportation system in the borough, has a small service area and
abbreviated service hours. In a borough the size of West Virginia, scheduled public
transportation is only available in the Palmer/Wasilla area and that service is very limited.
MASCOT has only one route between Palmer and Wasilla which has 29 stops and only
runs 6 times a day. MASCOT also makes one trip from Wasilla to Anchorage in the
morning and one outgoing trip from Anchorage to Wasilla in the evening. For people in
the communities of Knik, Big Lake, Houston, Meadow Lakes, or the Butte service is
available with a 24-hour advance phone call. If you do not live in one of the seven
communities served by MASCOT, there is no public transportation in the Mat-Su
Borough. Rates are $2.00 per bus ride for local routes and $2.50 for a trip into/out of
Eagle River or Anchorage. There is also a $5.00 all day pass or an $85 MASCOT
monthly pass. This is expensive transportation.
At community forums in both rural and core area communities, people voiced the need
for public transportation again and again. Seniors and those too ill to drive are unable to
attend medical appointments. People without a reliable vehicle or a valid driver’s license
also cannot access health care. Additionally, improved transportation would benefit not
just those lacking access to healthcare, but many others as well. In the community
forums, residents mentioned their children’s inability to participate in extracurricular
activities because the only way for them to get home is on the school bus immediately
after school. Others without a vehicle or driver’s license are prevented from being selfsufficient because they cannot get to a job. Many of those who do not have a vehicle or
license are also the people working retail jobs with later hours. The limited service hours
of MASCOT makes it challenging for those people to get to and from work.
Surprisingly, 98% of those responding the household survey reported having reliable
transportation. However, providers in the borough know that transportation is an issue.
It is frequently mentioned when patients call to cancel appointments or when
appointments are missed. Additionally, many providers in the borough offer
transportation services which are well used. The survey did not probe what people meant
by reliable transportation—respondents may have answered this question in the
affirmative if they have a good friend they can count on or if they consistently use the
transportation offered by their provider.
The lack of transportation to get to services was an issue that came up over and over with
the key informants. Respondents cited it as a barrier to accessing care, even for people
living in the core area or in the Upper Susitna where health care is available locally.
Seniors were mentioned most frequently as the group facing transportation issues.
Respondents felt seniors were less likely to drive and more likely to have health care
needs. Other groups mentioned as those with potential transportation issues included
households that share a car, especially if one parent stays at home during the day, or those
in rural areas with cars that were not reliable enough for a trip to the urban area.
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While a number of key informants noted that those in the rural areas are so used to
driving distances for everything that they are undeterred by the distances, most
respondents felt that the lack of adequate transportation was a bigger problem for people
in rural areas. Several respondents noted that housing was more affordable in the rural
areas, so those without the resources to maintain a vehicle were more likely to end up
further away from the urban area. The transportation issue was mentioned as barrier to
access. As a number of respondents noted, it does not matter if great services are
available in the borough if people are unable to get to them.
Other barriers
The issue of there being too few providers to serve the population, especially behavioral
health providers, was raised as a barrier to access by the key informants. The issue was
multi-dimensional as respondents noted that there were not enough providers relative to
the population to care for everyone and that certain types of specialists were lacking
entirely while there is a shortage of other specialists.
Many key informants noted that there were not enough general or family practitioners to
enable everyone to have a family doctor, if everyone could afford this. Many providers
have full practices and are not taking new patients. The other dimension of this issue that
was raised was the total lack of certain types of specialists and the inadequate supply of
others. The shortage of behavioral health services was raised by numerous people.
Respondents noted the lack of providers to handle any mental health crisis, the absence of
mental health providers specializing in treating youth, the inadequate supply of substance
abuse treatment services with a particular need for more detox was mentioned by many.
Other specialists which key informants felt the area needs included additional pediatric
dentists since there is currently only one, dermatologists, pediatricians, and cardiologists.
Many respondents expressed hope that with the new hospital, some specialists could be
available in the borough once a week. The burden of traveling to Anchorage for
treatment, especially for ongoing treatment or for those who are very sick was mentioned
by many respondents. Respondents were pleased that dialysis is now available in the
borough.
Another issue the key informants raised was the need for more providers who accept
Medicare and Medicaid. This issue was not nearly as big an issue as the prohibitive
expense of health care or the lack of transportation. However, nearly everyone
mentioned it. One of the main reasons this was mentioned with such frequency is that the
discussion of the high cost of health care nearly always led people to mention the
difficulty of finding a provider who accepts Medicare or Medicaid. Many respondents
were understanding about the inability of providers to accept a higher percentage of these
patients, given the reimbursement situation. In the course of discussing people unable to
afford health care, Denali Kid Care was typically mentioned. No one indicated any
trouble finding providers who will accept this coverage.
This issue of finding providers who will accept Medicare or Medicaid was mentioned
frequently in the community forums. Medicare was mentioned much more frequently
than Medicaid. Many people at the forums either had Medicare and said it was worthless
because no one would see you if that was your coverage. Others mentioned elderly
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neighbors or relatives that could not find a provider who would see them. People
mentioned driving to Anchorage in search of a provider who would accept this coverage.
Another issue that was raised in the community forums was that people had difficulty
navigating the system. They struggled to figure out what services were available at
which locations and what type of health coverage might be accepted. Other forum
attendees complained of not being able to locate a support group or find a class for their
health issue (such as diabetes education classes). Elderly forum participants said this was
very challenging and sometimes they were not successful at finding what they needed.
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The Health and Welfare of Residents of the Mat-Su
Borough
POPULATION CHARACTERISTICS
The Matanuska-Susitna (Mat-Su) Borough is the fastest growing community of the state.
Since 1970, the population of the Borough has grown from fewer than 10,000 residents to
more than 70,000 in 2004 (estimate). Most of the growth is attributed to residents from
Anchorage that take advantage of the more reasonable housing costs in the Valley.
The residents of the Borough are primarily White (87.6%) and Alaska Native (5.5%). The
median household income is $51,221. In 2000, 11.0% of the population had incomes
below the federal poverty level.
The Wasilla and Palmer communities are the population center of the borough. Most
business and industry are located here, including the majority of primary care services.
CHART 1
Population: 1970 to 2004
90,000
Fairbanks NSB
80,000
70,000
Mat-Su Borough
Population
60,000
50,000
Kenai Peninsula
40,000
30,000
Juneau Borough
20,000
10,000
0
1970
Information Insights, Inc.
1980
1990
2000
2004 (est.)
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Table 10 Composition of Residents in the Mat-Su Borough, 2000
Race
% of Children
White
87.6%
Alaska Native
5.5%
Black
0.7%
Asian
0.7%
Native Hawaiian/Pacific Islander
0.1%
Mixed Race
5.4%
Alaska QuickFacts, US Bureau of the Census,
http://quickfacts.census.gov/qfd/state/02/02170.html
CHRONIC DISEASE
The US Centers for Disease Control (CDC) reports that the costs of health care for people
with chronic diseases account for 75% of the nation’s total health care costs and that five
chronic diseases—heart disease, cancers, stroke, chronic obstructive pulmonary diseases,
and diabetes—account for more than two-thirds of all deaths in the United States.
Heart disease and cancer together account for more than half of all deaths in the United
States. Chronic obstructive pulmonary disease, which comprises bronchitis, emphysema,
asthma, and chronic airway obstruction, is the fourth most common cause of death, and
diabetes is the sixth.
Table 11 Deaths Due to Chronic Disease in the Mat-Su Valley: 1993
Matanuska-Susitna Borough
Cause of Death
Deaths
Alaska
Age Adjusted Rate
Age Adjusted Rate
Cancer
53
223.7
223.8
Lung Cancer
15
63.6
75.3
Breast Cancer
4
**
32.8
Diseases of the Heart
47
249.6
241.4
Coronary Heart Disease
40
190.1
175.9
Cerebrovascular Disease (Stroke)
10
83.3
62.3
6
**
27.0
16
85.1
67.6
201
932.7
914.8
Diabetes
Diabetes, any mention
All Causes
** Rates based on fewer than 10 occurrences are not reported.
Source: Health Profiles, Alaska Bureau of Vital Statistics, http://www.hss.state.ak.us/dph/bvs/
Profiles/body14.html
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This was also true for the Mat-Su Valley in 1993. The combined age-adjusted death rates
for cancer (223.7) and diseases of the Heart (249.6) were 473.3 deaths per 100,000
population, or 50.7% of the age-adjusted rate for all causes of death (932.7).
However, the combined rate for cancer (116.9) and diseases (182.7) of the heart fell to
299.6 per 100,000, or 39.7% of the rate for all causes, 754.2. The statewide rates
decreased in a similar fashion. The differences between statewide/Mat-Su rates and the
national rates may be due to the higher incidence of other causes of death, such as
intentional and unintentional injury.
Table 12 Deaths Due to Chronic Disease in the Mat-Su Valley: 2002
Matanuska-Susitna Borough
Cause of Death
Deaths
Alaska
Age Adjusted Rate
Age Adjusted Rate
Cancer
53
116.9
189.7
Lung Cancer
22
49.9
51.2
Breast Cancer
4
**
21.1
Diseases of the Heart
63
182.7
173.0
Coronary Heart Disease
45
124.2
118.2
Cerebrovascular Disease (Stroke)
15
55.8
55.4
6
**
21.7
24
71.2
67.8
288
754.2
800.7
Diabetes
Diabetes, any mention
All Causes
** Rates based on fewer than 10 occurrences are not reported.
Source: Health Profiles, Alaska Bureau of Vital Statistics, http://www.hss.state.ak.us/dph/bvs/
Profiles/body14.html
The Mat-Su Borough had the highest rate of death due to coronary heart disease when
compared to other similar municipalities on the road system. Mat-Su had an age-adjusted
rate of 94.0 deaths per 100,000 population over the period from 1990 to 1998. The City
and Borough of Juneau had the lowest rate of 68.6 deaths per 100,000.
Mat-Su Borough also had the second highest rate of death due to cancer between 1990
and 1998. The Kenai Peninsula Borough had the highest age-adjusted rate, 187.4 per
100,000 followed by Mat-Su’s rate of 165.5. The City and Borough of Juneau also had
the lowest rate for cancer deaths, 152.9 deaths per 100,000.
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Table 13 Age Adjusted Death Rates for Coronary Heart Disease
Borough
Number
Rate
Mat-Su
328
94.0
Fairbanks NSB
417
92.0
Kenai Peninsula
312
85.9
1,243
79.1
161
68.6
Anchorage
Juneau
Source: Health Status in Alaska, Alaska Division of Public Health, September 2001
Table 14 Age Adjusted Death Rates for Cancer
(Per 100,000 Population, 1990-1998)
Borough
Number
Rate
Kenai Peninsula
490
187.4
Mat-Su
442
165.6
2,007
165.1
Fairbanks NSB
569
161.7
Juneau
267
152.9
Anchorage
Source: Health Status in Alaska, Alaska Division of Public Health, September 2001
The 1998 Health Status Telephone Survey conducted by the Valley Hospital Association
found that 7% of respondents reported that they had been diagnosed with cancer, 17.8%
with high blood pressure, and 17.7% had high cholesterol. Respondents also reported a
number of respiratory diseases including asthma (12.6%), bronchitis (22.4%) and
allergies (24.8%).
Table 15 Chronic Disease Reported in the Mat-Su Borough: 1998
Health Status Telephone Survey
Diagnoses
%
Allergies
24.8%
Bronchitis
22.4%
High blood pressure
17.8%
High cholesterol
17.7%
Asthma
12.6%
Diabetes
7.5%
Cancer
7.2%
Emphysema
1.9%
Source: Health Status Telephone Survey of Matanuska-Susitna
Valley Residents, Valley Hospital Association, 1998
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HEALTH RISKS
The State of Alaska began the annual Behavioral Health Risk Factor Survey (BHRFS) in
1990 as a means of collecting uniform data on preventive health practices and risky
behaviors that contribute to chronic disease, injuries, and preventable diseases that are
among the leading causes of morbidity and mortality.
In the 1996 BHRFS, the Mat-Su Borough was combined with Anchorage, Fairbanks
North Star Borough, and the Southeast Fairbanks Census Area. In 2001, the Mat-Su
Borough was combined with Anchorage. Comparison of the 1996 and 2001 date for the
regions including the Mat-Su Borough show that there were slight decreases in the
percentage if residents reporting binge drinking or currently smoking. There were
somewhat larger increases in the percentage of respondents reporting chronic drinking
and that they had no health care plan. The most striking change was in the percentage of
respondents reporting that they were overweight. In 1996, the 95% CI range was 23.7% –
33.8% while in 2001 it was 58.4% - 68.4%.
Table 16 Behavioral Risks in the Mat-Su Borough: 1996 – 2001
(95% Confidence Intervals)
Behavioral Risk
1996*
2001*
Binge Drinking
14.0 – 22.7
13.5 – 21.8
1.4 – 5.0
2.8 – 6.4
Overweight
23.7 – 33.8
58.4 – 68.4
Current Smoking
21.0 – 30.7
19.3 – 27.8
No Health Care Plan
9.9 – 17.5
14.1 – 22.4
Chronic Drinking
* 95% Confidence Interval: The range of values within which the true value of a
prevalence estimate would be expected to fall 95% of the time.
Source: 2000-2001 and 1996 Behavioral Risk Factor Surveys, Alaska Division of Public
Health
Table 17 Health Risks Reported in the Mat-Su Borough: 1998
Health Status Telephone Survey
Health Risk
%
Use tobacco products
31.0%
Do not have health insurance
21.7%
Do not exercise
25.6%
Exercise, but less than 3 times/week
18.3%
Source: Health Status Telephone Survey of Matanuska-Susitna Valley Residents, Valley
Hospital Association, 1998
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The Health Status Telephone Survey conducted by the Valley Hospital Association in
1998 found that 31% of Mat-Su Borough residents use tobacco products (mostly
cigarettes), 43.9% exercise less than the recommended 3 times per week (21.7% never
and 18.3% once or twice a week), and 21.7% do not have health insurance.
Table 18 Tobacco Use in the Anchorage/Mat-Su Borough Region
2000-2002 BRFSS
Diagnoses
%
Adults who smoke
25.1%
Adults who use smokeless tobacco
4.7%
Source: Tobacco in the Great Land: A Portrait of Alaska’s Leading Cause
of Death, Alaska Division of Public Health, 2004
COMMUNICABLE DISEASE
The State of Alaska Department of Health and Social Services Section of Epidemiology
is responsible for collecting information on the incidence of infectious diseases, including
HIV/AIDS and sexually transmitted diseases. The State is responsible for coordinating
surveillance and control efforts for all infectious diseases of public health importance,
and discovering and controlling outbreaks as they occur.
Among the sexually transmitted diseases monitored by the state are gonorrhea and AIDS.
In 1999, there were only 5 cases of gonorrhea reported in the Mat-Su Borough. The
cumulative number of AIDS cases (20) reported in the borough is also relatively low.
Table 19 Gonorrhea Cases by Borough: 1999
Borough
Anchorage
Fairbanks NSB
Cases
158
27
Mat-Su
5
Kenai Peninsula
4
Juneau
3
Source: Health Status in Alaska, Alaska Department of
Health and Social Services, September 2001
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Table 20 AIDS Cases by Borough of Residence at Diagnosis
Data Cumulative as of June 30, 1999
Borough
Anchorage
Cases
296
Fairbanks NSB
41
Kenai Peninsula
24
Mat-Su
20
Juneau
21
Source: Health Status in Alaska, Alaska Department of
Health and Social Services, September 2001
Tuberculosis (TB) is one of the more actively monitored infectious diseases in Alaska.
The TB rate in the Mat-Su/Anchorage region was 7.2 cases per 100,000 population in
1995-1999, significantly below the rates found in more rural regions. The Northern
Region rate for the same period was 75.5/100,000.
Influenza is also part of the statewide surveillance system. Since the beginning of the
2004 flu season, there were 82 cases of Influenza A and 10 cases of Influenza A/B
cultured and verified in the Mat-Su/Anchorage Region.
INJURY
Injury (intentional and unintentional) is the third leading cause of death for Alaskans
overall and the leading cause of death from age one through 44. The State of Alaska
Injury Surveillance and Prevention Program (ISAPP) collects data on all injury deaths
and hospital admissions and manages prevention programs aimed at reducing the number
of serious and fatal injuries in the state.
The Alaska Department of Health and Social Services reported that there were 22 deaths
due to unintentional injury in the Mat-Su Valley in 1993. Ten of the deaths involved
motor vehicle accidents, air transport accidents and falls each accounted for 3 deaths. In
2002, the leading cause of death due to unintentional injury was poisoning while motor
vehicle accidents accounted for another 13 deaths. The small number of deaths due to
other causes make it difficult to determine trends or to compare Mat-Su age-adjusted
rates to statewide rates.
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Table 21 Deaths Due to Unintentional Injury in the Mat-Su Valley: 1993
Matanuska-Susitna Borough
Cause of Death
Deaths
Age Adjusted Rate
Alaska
Age Adjusted Rate
Motor Vehicle Accidents
10
21.5
20.0
Air Transport Accidents
3
**
4.5
Falls
3
**
7.4
Drowning and Submersion
2
**
3.8
Accidental Discharge of Firearms
1
**
0.5
Exposure to Smoke, Fire, Flame
1
**
2.4
Suffocation/Choking
1
**
2.9
Other Accidental Deaths
1
**
5.0
Total Accidental Deaths
22
67.2
55.7
** Rates based on fewer than 10 occurrences are not reported
Table 22 Deaths Due to Unintentional Injury in the Mat-Su Valley: 2002
Matanuska-Susitna Borough
Cause of Death
Deaths
Age Adjusted Rate
Alaska
Age Adjusted Rate
Poisoning
16
22.3
11.1
Motor Vehicle Accidents
13
25.2
16.4
Air Transport Accidents
5
**
2.7
Falls
2
**
3.9
Snow Machine Related Accidents
1
**
2.0
Suffocation/Choking
1
**
2.4
Other Accidental Deaths
5
**
11.4
43
69.6
59.2
Total Accidental Deaths
** Rates based on fewer than 10 occurrences are not reported
The Alaska Injury Prevention Center conducted a series of bike and ATV helmet
observations in Alaskan communities between May 2000 and May 2001. They observed
a total of 360 bike riders (of whom 82 were adults) in the Palmer/Wasilla area and found
that only 38% of the adults wore bike helmets. Over the same period, they observed 61
ATV riders (of whom 33 were adults) and only 33% of the adults wore helmets.
The Mat-Su Borough had a relatively high number of traumatic brain injury cases when
compared to boroughs of similar size. Between 1996 and 1998, there were 209 cases
reported in Mat-Su, which was more than Southeast Alaska (182) and the Fairbanks
North Star Borough (167), both of which had larger populations at the time.
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Table 23 Traumatic Brain Injury: 1996-1998
Borough
Cases
Anchorage
681
Mat-Su
209
Southeast (including Juneau)
182
Fairbanks NSB
167
Kenai Peninsula
156
Source: Traumatic Brain Injuries in Alaska, 1996-1998, Dept. of
Health and Social Services
As part of the 1998 Health Status Telephone Survey, respondents were asked about
behaviors that often lead to intentional or unintentional injuries. The survey found that
25.1% of respondents sometimes or never wore seat belts and 22.6% sometimes or never
require others to wear seat belts. Respondents were asked if they had ever considered
suicide (16.9%) or attempted suicide (7.7%) and 6.5% said that they didn’t have smoke
alarms in their homes.
Table 24 Potential Causes of Injury Reported in the Mat-Su Borough: 1998
Health Status Telephone Survey
Potential Causes of Injury
%
Sometimes/never wear seatbelt
25.1%
Sometimes/never require others to wear seatbelt
22.6%
Thoughts of suicide
16.9%
Attempted suicide
7.7%
No smoke alarms in home
6.5%
Source: Health Status Telephone Survey of Matanuska-Susitna Valley
Residents, Valley Hospital Association, 1998
The telephone survey respondents were also asked if they had ever been the victims of
family violence. Sexual abuse (15.0%) was the most frequently cited form of family
violence, followed by physical abuse (14.4%) and domestic violence (13.7%).
Table 25 Family Violence Reported in the Mat-Su Borough: 1998
Health Status Telephone Survey
Victim of …
%
Domestic violence
13.7%
Physical abuse
14.4%
Sexual abuse
15.0%
Source: Satus Telephone Survey of Matanuska-Susitna
Valley Residents, Valley Hospital Association, 1998
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CAUSE OF DEATH
The five leading causes of death for residents of the Mat-Su Borough in 1993 and 2001
included diseases of the heart, malignant neoplasms, unintentional injuries, intentional
injuries, and cerebrovascular diseases. The #1 cause of death in 1993 was malignant
neoplasms while the leading cause in 2001 was diseases of the heart.
The age-adjusted rates (per 100,000 population) for diseases of the heart (249.6 in 1993
and 182.7 in 2001), malignant neoplasms (223.7 and 116.8), and cerebrovascular diseases
(83.2 and 55.8) dropped considerably between 1993 and 2001. The rates for intentional
and unintentional injuries remained the same.
Table 26 Five Leading Causes of Death in the Mat-Su Valley: 1993
Matanuska Susitna Borough
Cause of Death
Deaths
Age Adjusted Rate
Alaska
Age Adjusted Rate
Malignant Neoplasms
53
223.7
223.8
Diseases of the Heart
47
249.6
241.3
Unintentional Injuries
22
67.2
55.7
Intentional Self-Harm
12
23.7
23.5
Cerebrovascular Diseases
10
83.2
62.2
Source: Health Profiles, Alaska Bureau of Vital Statistics, http://www.hss.state.ak.us/dph/bvs/
Profiles/body14.html
Table 27 Five Leading Causes of Death in the Mat-Su Valley: 2001
Matanuska-Susitna Borough
Cause of Death
Deaths
Age Adjusted Rate
Alaska
Age Adjusted Rate
Diseases of the Heart
63
182.7
173.0
Malignant Neoplasms
53
116.8
189.7
Unintentional Injuries
43
69.6
59.2
Cerebrovascular Diseases
15
55.8
55.3
Intentional Self-Harm
15
21.4
20.8
Source: Health Profiles, Alaska Bureau of Vital Statistics, http://www.hss.state.ak.us/dph/bvs/
Profiles/body14.html
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MATERNAL, CHILD, AND FAMILY HEALTH
General Demographics
There were 20,700 children and youth under the age of 20 living in the Mat-Su Borough
in 2000 of whom 4,147 (20.0%) were under 4 years old or younger, 5,202 (25.1%) were
between 5 and 9 years of age, 6,034 (29.1%) were between 10 and 14 years old, and
5,317 (25.7%) were 15 to 19 years old.
Of the 20,700 children and youth, 9,910 were female and 10,790 were male, a ratio of
108.9 males per 100 females.
The racial composition of the borough’s children and youth reflects that of the population
as a whole. The largest racial group among those under 20 years old is White (85%),
followed by Alaska Native (11.7%), Black (0.7%), Asian (0.6%), Native
Hawaiian/Pacific Islander (0.2%), and Mixed Race (1.9%).
There are 15,057 family households in the Mat-Su Borough, of which 12,109 (80.4%)
households are a married couple. There were 1,868 (12.4%) female-headed households in
the Borough in 2000.
Table 28 Children in the Mat-Su Borough: 2000
Age Group
#
Birth to 4 years old
4,147
5 to 9 years old
5,202
10 to 14 years old
6,034
15 to 19 years old
5,317
Total
20,700
Source: American Fact Finder, U.S. Census Bureau,
http://factfinder.census.gov/servlet/SAFFPeople?_sse=on
Table 29 Racial Composition of Children (19 and Under)
in the Mat-Su Borough, 2000
Race
% of Children
White
85.0
Alaska Native
11.7
Black
0.7
Asian
0.6
Native Hawaiian/Pacific Islander
0.2
Mixed Race
1.9
Source: Kids Count Alaska 2003, Institute of Social and Economic Research, University of
Alaska Anchorage
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Family Income and Poverty
The median income for families living in the Mat-Su Borough in 2000 was $56,939.
There were 1,175 (7.5%) families with incomes that fell below the federal poverty level.
Families with children under 18 years old (11.3%) were more likely to be below the
poverty level and families with related children under 5 years old (17.3%) had the highest
number of families below poverty.
Female-headed households with no husband present were even more at risk of living in
poverty. Nearly a quarter (23.5%) of all female headed households fell below the poverty
level, while 51.9% of those with children under 5 years of age were living in poverty.
Table 30 Family Income: 2000
Family Income
Number
Percent (%)
Less than $10,000
636
4.2
$10,000 to $14,999
609
4.0
$15,000 to $24,999
1,331
8.8
$25,000 to $34,999
1,441
9.5
$35,000 to $49,999
2,265
15.0
$50,000 to $74,999
3,926
25.9
$75,000 to $99,999
2,451
16.2
$100,000 to $149,999
1,834
12.1
$150,000 to $199,999
366
2.4
$200,000 and more
288
1.9
Source: American Fact Finder, U.S. Census Bureau,
http://factfinder.census.gov/servlet/SAFFPeople?_sse=on
Table 31 School Children Ages 5 to 17 Receiving Public Assistance*
Selected Districts, 2001-2002 School Year
School District
%
Mat-Su
37%
Anchorage
28%
Fairbanks North Star
23%
Juneau
22%
*Includes Temporary Assistance, Medicaid and Food Stamps
Source: Kids Count Alaska 2003, Institute of Social and Economic Research,
University of Alaska Anchorage
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In 2000, 1,826 (8.9%) households in the Mat-Su Borough received an average of $4,001
in Public Assistance. The Mat-Su School District reported that 37% of enrolled students
between the ages of 5 and 17 received Temporary Assistance, Medicaid or Food Stamps
during the 2001-2002 school years.
More than half (52.9%) of families with children under 6 years old have all parents in the
labor force.
Births
The Alaska Vital Statistics Bureau reports that between 1990 and 2003, the number of
births in the Mat-Su Borough grew from 686 to 904, an increase of 31.8%.
Fewer women are reporting drinking and smoking during pregnancy. In 1990, 2.3%
reported drinking and 20.4% reported smoking. In 2003, these percentages dropped to
1.6% (drinking) and 15.4% (smoking).
Table 32 Percent of Mothers Receiving Less Than Adequate Prenatal Care
5-Year Average, 1997-2001
% Less Than Adequate Care
Region
Inadequate
Intermediate
Total
Southwest
49.7
9.6
59.3
Northern
40.9
6.5
47.4
Interior
31.6
6.0
37.6
Gulf Coast
29.7
3.4
33.1
Mat-Su
24.7
5.1
29.8
Southeast
25.5
2.2
27.7
Anchorage
17.5
2.3
19.8
Source: Kids Count Alaska 2003, Institute of Social and Economic
Research, University of Alaska Anchorage
Women were more likely to give birth in a hospital in 1990 than in 2003. During 1990,
94.2% of all births took place in hospitals. Home births (4.7%), and births at other
facilities (1.0%) and outside Alaska account for the remainder of the births in 1990. In
2003, 88.3% of births took place at hospitals. Birthing centers accounted for 7.5% of
births and 3.7% of the babies were delivered at home.
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Table 33 Percent of Alaska Babies with Low Birth Weight, by Region
5-Year Average, 1997-2001
Region
% of Births
Anchorage
6.3
Mat-Su
6.2
Gulf Coast
5.9
Northern
5.8
Interior
5.6
Southwest
5.2
Southeast
3.8
Source: Kids Count Alaska 2003, Institute of Social and Economic Research,
University of Alaska Anchorage
The percentage of women receiving adequate+ or adequate pre-natal care increased from
65.4% to74.0% between 1990 and 2003. Over the same period, the percentage of babies
born pre-term increased from 5.8% to 9.6% and the percentage of babies born with low
birth weight grew from 2.9% to 4.9%.
Between 1990 and 2003, the number of births to women under 20 years old who gave
birth rose from 68 (9.9% of births) to 104 (11.5%). While there were no births to young
women under 15 years old in 1990, there were 4 in 2003. The birth rate for teens in the
Mat-Su region averaged 33.2/1000 girls over the five year period of 1997 to 2001.
Table 34 Birth Rate for Teens by Region
Per 1000 Girls, 5-Year Average, 1997-2001
Region
Rate/1000
Northern
94.1
Southwest
78.2
Anchorage
47.5
Interior
46.8
Gulf Coast
38.7
Southeast
37.2
Mat-Su
33.2
Source: Kids Count Alaska 2003, Institute of Social and Economic Research,
University of Alaska Anchorage
In the 1998 Health Status Telephone Survey conducted by the Valley Hospital
Association, 21% of telephone survey respondents reported that they had a child before
they were 20 years old.
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Education
The Mat-Su Borough School District is the fastest growing district in the state. Between
1988 and 2004, enrollment (average daily membership) grew from 8,605.75 to 14,304.06,
an increase of 66.2%. The Mat-Su School District is growing more than twice as fast as
the Anchorage School District (27.2%), which is the second fastest growing district.
Table 35 School District Enrollment: 1988 and 2004
1988
Enrollment
2004
Enrollment
%
Increase
8,605.75
14,304.06
66.2%
38,734.41
49,264.98
27.2%
Juneau
4,492.96
5,441.87
21.1%
Kenai Peninsula
8,003.33
9,561.95
19.5%
13,194.95
14,594.39
10.6%
School District
Mat-Su Borough
Anchorage
Fairbanks North Star Borough
Source: Average Daily Membership by Districts FY88-FY04, Alaska Department of Education
and Early Development, http://www.eed.state.ak.us/stats/QuickFacts/ADM.pdf
Table 36 Percentage of Dropouts (Grades 9-12) by Region: 2001-2002
Region
Percent (%)
Southwest
12.5
Northern
10.0
Interior
8.7
Anchorage
8.6
Southeast
7.1
Mat-Su
6.3
Gulf Coast
6.0
Source: Kids Count Alaska 2003, Institute of Social and Economic Research,
University of Alaska Anchorage
Of the 3,925 youth between the ages of 16 and 19, 3,142 (80.1%) were enrolled in
school. There were 337 (8.6%) young people in this age group who were not enrolled in
school and not high school graduates.
During the 2001-2002 school year, 6.3% of the students in 9th through 12th grades in the
Mat-Su School District dropped out of school.
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Injury
During the years 1994 to 1998, motor vehicles were the most common (26.4%) cause of
serious or fatal injuries to children and adolescents in the Mat-Su Borough. Other causes
were falls (14.1%), suicide (9.1%) and other (50.3%). In all, there were 481 serious and
fatal injuries.
Mat-Su Borough youth have a relatively low rate of serious or fatal firearm injuries when
compared to many other areas of the state. There were 19 firearm injuries to youth living
in the borough from 1991 to 1997, or a rate of 16 injuries /100,000 youth.
Table 37 Child and Adolescent Injuries in the Mat-Su Borough: 1994-1998
Injury Category
#
%
127
26.4%
Falls
68
14.1%
Suicide
44
9.1%
242
50.3%
481
99.9%
Motor Vehicle
Other
Total
Source: Serious and Fatal Child and Adolescent Injuries in Alaska: 1994-1998, Alaska
DHSS Division of Public Health
The Alaska Injury Prevention Center conducted a series of bike and ATV helmet
observations in Alaskan communities between May 2000 and May 2001. They observed
a total of 360 bike riders (of whom 278 were children or teens) in the Palmer/Wasilla area
and found the only 35% of children and 9% of the teens wore bike helmets. Over the
same period, they observed 61 ATV riders (of whom 28 were children or teens) and 62%
of the children and 53% of the teens wore helmets.
In the 1998 Health Status Telephone Survey conducted by the Valley Hospital
Association, 29.1% of respondents reported that they always require their children to
wear bike helmets and 42.8% always require ATV helmets. Only 4.6% never require
their children to wear ATV helmets while 42.8% never require bike helmets.
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Table 38 Serious and Fatal Firearm Injuries, Ages 0-19
(Rate/100,000 Youth) 1991-1997
Region
Injuries
Rate/100,000
Youth
Yukon-Kuskokwim
71
105
Norton Sound
26
100
Northwest Arctic
16
75
Bristol Bay
11
54
Interior (not including Fairbanks)
20
53
North Slope
10
50
Kodiak
9
26
Prince William Sound/Copper River
6
26
Anchorage
125
22
Southeast
28
17
Mat-Su
19
16
Fairbanks North Star Borough
28
14
Kenai Peninsula
15
14
3
*
Aleutian-Pribilofs
Source: Serious and Fatal Firearm Injuries Among Children and Adolescents in Alaska:
1991-1997, Alaska DHSS Division of Public Health
Cause of Death
The Alaska Bureau of Vital Statistics reported that, in 2000, the most frequent cause of
death of Alaskan children from birth to 4 years old was conditions originating in the prenatal period. The most common cause of death for children and young adults between the
ages of 5 and 14 and 15 and 24 was unintentional injuries.
The rate of children who die in the first 12 months of life in the Mat-Su Valley is slightly
higher than the statewide rate. The state rate for 1997 to 2001 was 6.9/1000 live births
while the rate for Mat-Su Borough was 7.2/1000 live births.
In 2000, there were 25 deaths of children and young adults including 7 children between
birth and 4 years old, 7 children from 5 to 14 years old, and 11 young adults who were 15
to 24 years old. The child (1 to 14 years old) death rate for the borough is 37.5
deaths/100,000 children.
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Table 39 Infant Mortality Rate by Region
Per 1000 Live Births, 5-Year Average, 1997-2001
Region
Rate/1,000
Southwest
12.9
Northern
10.2
Mat-Su
7.2
Southeast
6.2
Anchorage
6.2
Interior
5.6
Gulf Coast
5.3
Source: Kids Count Alaska 2003, Institute of Social and Economic Research,
University of Alaska Anchorage
Table 40 Child Death Rate by Region Per 100,000 Children (1-14)
5-Year Average, 1997-2001
Region
Rate/100,000
Southwest
77.8
Northern
68.5
Mat-Su
37.5
Interior
30.7
Gulf Coast
25.7
Anchorage
24.8
Southeast
10.1
Source: Kids Count Alaska 2003, Institute of Social and Economic
Research, University of Alaska Anchorage
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Current Providers and Service Utilization in the
Mat-Su Borough
In order to understand the healthcare system in the Mat-Su Borough, efforts were made to
learn what providers were serving the borough, where those providers’ patients live and
where patients get care.
EXISTING PROVIDERS
The first step toward understanding healthcare needs and access issues in Mat-Su was to
compile a list of existing providers. The list was compiled using six sources:
•
2004-2005 MTA phone book;
•
Public health list of Mat-Su providers;
•
Directory of Alaska Health Care Sites, Volume 2, March 2004, produced by the
Alaska Department of Health and Social Services, Primary Care and Rural Health
Unit;
•
Suggestions from members of the Rural Healthcare Planning Network;
•
Providers mentioned at community forums; and
•
Providers named by other providers during calls with providers and key informant
interviews.
There was significant overlap between the lists, although some new information was
gained from each list. The use of many data sources allowed duplicate providers to be
removed from the final list as well as enabling the list to be closer to having no
omissions. Many single-provider practices will have a name for their practice, e.g.,
Camelot Family Health which consists of one physician. Some lists named the practice
name while others listed the provider’s name. Many people would reference a provider
by his or her name, e.g., “Did you get Dr. Anzilotti in Willow?”, when his practice is
called the Heart of Willow Clinic. All clinic and provider names were included on the
list to help people find the individual or practice they want and avoid duplications or
omissions.
The following provider totals were generated based on these methods.
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Table 41 Mat-Su Borough Primary Care Providers
Provider Type
Estimated #
Primary care physicians (including pediatricians,
OB/GYN, and internists)
42
Primary care mid-levels (ANP, PA, CNM)
22
Specialty physicians
51
Oral health providers (dentists & orthodontists)
35
Behavioral health providers
26
Chiropractors
10
Physical & occupational therapists
18
A method of learning the number of current providers that seems obvious is to check with
the state for the number of licensed providers in an area. However, this method is much
less reliable than might be imagined. It has several problems. As mentioned, many
people commute between the Mat-Su Borough and Anchorage. This phenomenon does
not exclude healthcare providers. The address on a license may be a provider’s residence
and does not reflect where they practice. Another issue with checking for current
licenses is there is no way to know whether someone is currently practicing. Based on
national data, the number of providers currently practicing is typically much lower than
those with a current, valid license. (Many providers maintain their license during periods
when they may not be practicing—it is much easier to maintain a license than to obtain
one after an expiration.) The final problem is that licenses do not indicate what
percentage of full time a provider is working. Thus for example, there may be 100
currently licensed providers with an address in the Mat-Su Borough, 20 may work in
Anchorage, 10 may be retired, and another 20 might only work part time.
UTLILIZATION
Once the existing providers and their locations were identified, the next step was to figure
out who the providers were serving. Attempts were made to contact nearly all providers
on the list (a few providers came onto the radar screen too recently to contact them for
this report). The vast majority—84%--of the practices were successfully contacted.
However, not everyone contacted was willing to answer the short questionnaire. Only
45% of the practices answered the questions, with physical and occupational therapists
the most likely to answer the questionnaire. See Table 42 below for complete results.
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Table 42 Primary Care Telephone Survey
# of Clinics or
Practices
Successful Contacts
(% Contacted)
Completed Survey
(% Completed)
Physicians
27
21 (77.8%)
11 (40.7%)
Dentists and Orthodontists
28
26 (92.9%)
13 (46.4%)
Chiropractors
11
8 (72.7%)
4 (36.4%)
7
6 (85.7%)
5 (71.4%)
73
61 (83.6%)
33 (45.2%)
Type of Provider
Physical & Occupational Therapists
Total
All providers who were successfully contacted were asked for hard data on the numbers
of people they served. However, smaller practices do not have data in a fashion that
would allow them to easily share it. Additionally, they had concerns about HIPAA even
though the only data sought were data with all identifying information stripped. A
handful of large providers--Valley Hospital, AIC, the Sunshine Community Health
Clinics and the Public Health Center—were willing and able to provide hard data
concerning some aspects of their service provision. The findings are displayed in Chart 2
below.
CHART 2 Patients Origin by Provider (N=77,713)
100.0
96.7
100.0
90.0
90.7
86.1
94.0
90.3
98.2
93.1
99.1
94.0
97.0
97.6
92.9
99.6
93.5
88.3
80.0
70.0
60.0
50.0
40.0
30.0
20.0
10.0
0.0
Sunshine
Clinic,
Talkeetna
Sunshine
Clinic,
Willow
Sunshine
Clinic,
mobile
Valley
Hospital,
inpatient
Valley
Hospital,
outpatient
Valley
Valley
Hospital, ER Hospital, AIC
Public
Health
Nurses
Health Care Provider
Patients from Alaska
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As shown, the Sunshine Community Health Clinic in Talkeetna had the smallest
percentage of patients who were residents of the Mat-Su Borough. This is not surprising
given their location closer to the border of the borough and close to intensive tourist
activities. The emergency room at Valley Hospital had the second lowest number of
patients who were Mat-Su Borough residents. Again, this is predictable given that this is
the only ER in the borough. All other facilities drew at least 90% of their patients from
the borough’s population.
Data gathered from the completed calls with borough providers indicates a fairly
consistent and similar percentage of patients drawn from the Wasilla and Palmer area.
Providers were grouped into the following categories: general practice clinics and
physicians, dentists and orthodontists, and chiropractors, physical therapists and
occupational therapists. Table 43 below highlights the results.
Table 43 Patient Origin by Provider Type
Provider Type
% of Patients from
Wasilla & Palmer
% of Patients from
Other Mat-Su Areas
General Practice Clinics & Physicians
84.3 %
15.7 %
Dentists & Orthodontists
92.3 %
7.7 %
Chiropractors, Physical Therapists &
Occupational Therapists
89.4 %
10.6 %
Most providers estimated that more than seventy-five percent of their patients who live
outside the Wasilla and Palmer area are primarily from more rural locations within the
Mat-Su Borough. They estimated they have very few patients from the Eagle River or
Chugiak areas.
The Mat-Su Borough still does not have enough specialists to prevent people from
needing to travel to Anchorage for some specialties. However, referrals predominantly
stayed within the Wasilla and Palmer area, unless it was a specialty that could not be
served. With the continued rapid growth of the Mat-Su Borough, it is only a matter of
time before those services are available in the borough.
Providers were asked about their capacity, both in terms of how many patient episodes
they had in a year and how many providers were at the facility. The average number of
providers per facility does not reflect the number of doctors per facility. The number of
primary providers per facility was closer to 1.5 with assistants, nurses, and hygienists
compensating the remaining value of the rate. The exact figures are available below in
Table 44.
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Table 44 Provider Practice Characteristics
Average
providers/facility
Provider Type
Average
treatment
episodes/year
Average
episodes/
provider/year
General Practice Clinics & Physicians
2.43
6,373
2,626
Dentists & Orthodontists
2.95
5,219
1,771
Chiropractors, Physical Therapists &
Occupational Therapists
1.23
5,836
4,750
Providers were also asked what type of insurance they accept since that is a primary
driver of what providers people see and where and if they seek care. As shown in Table
45 below, for physicians roughly one quarter of patients had Medicare, while just over
one third of patients had Medicaid, 30% of patients had private insurance, with the
remaining 10% having no insurance coverage. Among the dentists contacted, the
majority (63%) of their patients were covered by private insurance, with over one-fifth
(22%) having no insurance, and 15% of their patients having Medicaid. A common
theme among all providers sampled is the difficulty of accepting Medicare or Medicaid
patients. Because of lower compensation rates and slow reimbursement times, providers
are forced to limit these forms of insurance and many times refuse service to new
Medicare and Medicaid clients.
Table 45 Third Party Payment Sources
% of Patients with…
Provider Type
Medicare
Medicaid
Private Insurance
No Insurance
23.7 %
36.3 %
29.5 %
10.5 %
0%
15.1 %
63.1 %
21.8 %
General Practice Clinics & Physicians
Dentists & Orthodontists
WHERE PEOPLE RECEIVE CARE
Based on the community forums, most people get healthcare in Palmer and Wasilla.
There were some exceptions such as people with military ties, seniors with Medicare, and
anyone needing a certain specialists. Some people from every community travel to
Anchorage for healthcare. The communities on the edges of the borough, not
surprisingly, tend to get their healthcare less consistently from the Palmer/Wasilla area.
Lake Louise and Glacier View residents sometimes go to Glenallen, while residents of
the Upper Susitna (and Skwentna) go to Talkeetna.
The household survey also asked respondents about where they receive care. Among
respondents, the vast majority are receiving their primary care in the Mat-Su Borough.
Nearly 82% said they received their primary care in the borough with 74% of those
people receiving care in the Palmer or Wasilla area. The rates are only slightly lower for
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dental care with 78% of respondents reporting receiving dental care in the Mat-Su
Borough with 77% of those receiving care in the Palmer or Wasilla area.
The case for specialists was very different with more people receiving care in Anchorage
(49.7% of those seeing a specialist) than in the Mat-Su Borough (43.9% of those seeing a
specialist). While 75% of those using behavioral health services received them in the
Mat-Su Borough, only 34% of the sample reported using such services. Ancillary
services like obtaining prescription drugs, x-rays, or physical therapy was the item people
reported most frequently using in the Mat-Su Borough, with 84% using these services in
the borough.
Table 46 Location of Primary Care Services Used by Mat-Su Borough Residents
Primary Care Type
Respondents
Using Primary
Care Services (n)
Mat-Su (n)
Palmer or
Wasilla (n)
Anchorage (n)
Primary Care Medicine
98.0% (392)
81.9% (321)
73.7% (289)
15.5% (62)
Medical Specialist
85.5% (342)
46.2% (158)
43.9% (150)
49.7% (170)
Dental Care
96.3% (385)
78.2% (301)
76.6% (296)
17.4% (67)
Behavioral Health Care
34.0% (136)
77.9% (106)
75.0% (102)
20.6% (28)
Other Health Services
94.5% (378)
83.6% (316)
81.2% (307)
15.6% (59)
The main reason respondents gave for leaving the Mat-Su Borough to receive services
varied depending on the service. The most common reasons were either that respondents
had to leave for coverage or another reason. For specialist care, the most frequently cited
reason was that there were higher quality or more skilled providers elsewhere. “Another
reason” was a frequent answer choice—some of the reasons given include the following:
48
•
Care too expensive in Mat-Su
•
More choices in Anchorage
•
Too long to wait for an appointment in Mat-Su
•
Referred to Anchorage by their Mat-Su provider
•
Have an established relationship with Anchorage provider because they used to
live there or before service was available in Mat-Su
•
Service not available in Mat-Su (this should have been coded as Closest provider
not in Mat-Su)
•
Provider in Anchorage recommended by acquaintance
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Table 47 Reasons for Seeking Primary Care Elsewhere
Reason for Seeking Care Elsewhere…
Type of Primary Care
Primary Care Medicine
Medical Specialist
Dental Care
Behavioral Health Care
Other Health Services
Receiving
Care
Elsewhere
Must for
coverage
Convenience,
already
somewhere
else
Higher quality
/more skilled
providers
elsewhere
Closest
provider
not in
Mat-Su
Another
reason
24.3% (97)
33.0% (32)
16.5% (16)
17.5% (17)
4.1% (4)
28.9% (28)
52.0% (208)
18.3% (38)
11.1% (23)
32.7% (68)
19.2% (40)
18.8% (39)
23.0% (92)
23.9% (22)
21.7% (20)
15.2% (14)
0.0% (0)
39.1% (36)
8.3% (33)
(11)
(3)
(9)
(3)
(7)
19.8% (79)
31.6% (25)
15.2% (12)
12.7% (10)
5.1% (4)
35.4% (28)
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The Model for Healthcare Services
Once data had been collected about the existing services in the borough, the access
challenges faced by residents, and the thoughts of key informants had been included, it
was time to think about methods for determining the level of services needs through the
borough. The borough is a large area with a growing population. It is also a very unique
area, as was determined when trying to locate a useful model for determining service
need.
SERVICE AREAS FOR THE MAT-SU BOROUGH
Because the Mat-Su Borough is such a large geographic area and the communities are so
spread out, one of the first steps was to determine which communities could be grouped
together for service provision. A number of existing service groupings were examined.
Communities that are served by shared schools at some grade levels were examined. The
clusters of communities that share emergency services were examined. Additionally,
during interviews and in community forums residents were asked about their travel
patterns within the borough.
The state has developed a levels of community system that it uses for categorizing types
of communities by size and access to roads. However, it was not the ideal model for the
borough because it was not developed with the idea of clustering communities.
After looking at other patterns of service delivery, the characteristics of communities and
through discussion with the RHPN, the communities were grouped into the following
eight service areas. See Appendix A for a map of the areas.
Table 48 Primary Care Service Areas
Service Area
Communities
Core area
Farm Loop, Fishhook, Gateway, Lakes (north & south), Palmer, Tanaina, Wasilla
Old Glenn Hwy
Butte, Knik River, Lazy Mountain
Glenn Hwy South
Buffalo/Soapstone, Chickaloon, Sutton
Glenn Hwy North
Glacier View, Lake Louise
Knik Goosebay Rd
Knik/ Fairview, Point MacKenzie
South Parks Hwy
Big Lake, Houston, Meadow Lakes
Upper Susitna Valley
Chase, Petersville, Talkeetna, Trapper Creek, Willow, Y
Off Road
Skwentna, Susitna
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HEALTHCARE MODELS
Given all that was known about the health of residents of the Mat-Su Borough and the
status of the healthcare system in the borough, the next step was to seek out planning
constructs. Efforts were made to find communities Outside that were similar to the MatSu Borough so their provider levels could be examined. Counties were sought on three
criteria--counties with similar populations, counties with similar growth rates, and
counties of similar size and population density. None of the Outside counties were a
good match. Most of the counties that also had very high rates of growth like the Mat-Su
Borough were near a very large city (e.g. outside San Antonio or Atlanta). Those
counties with similar populations were not growing like the Mat-Su Borough and had
population densities an order of magnitude higher than the borough. The large counties
with low population densities that might have been a good match were in Arizona and
Nevada. Those counties were only about 3/4th the size of the Mat-Su Borough and were
poor matches because the area is deserted with the nearest city of any size hundreds of
miles away (e.g., 211 miles to Las Vegas).
Another approach taken was to look for recommended provider to population ratios.
Loose recommendations were found regarding the ratio of providers to population needed
to qualify an area as a Health Professional Shortage Area (HPSA) area as designated by
the federal government. However, that is not a desired standard, but viewed as the edge
of acceptable provider to population ratios.
Provider planning models created by the Indian Health Service and the University of
Oregon Health Sciences were examined. Both of these models calculate the needed
number of providers based on the average number of visits made by certain populations.
The Indian Health Service model was rejected because the assumptions regarding the
numbers of healthcare visits per person per year were deemed to be much higher than
appropriate for the general population of the Mat-Su Borough. Usage among those
covered by the Indian Health Service is higher than average for a variety of reasons.
The Indian Health Service model does allow for different assumptions to be used
regarding the number of visits per patient per year. The model was run several times
using different usage assumptions. One assumed 2 visits per person per year, another 4
visits per person per year, another was the IHS default workload which assumes 3.7 visits
per person per year, and finally a scenario using the CDC rate for office visits to all
physicians nationwide which was 3.14 visits per person per year. The IHS model makes
its calculations based on overall population without regard to the age or gender of the
population. The IHS model projects primary care providers, which include physicians
and mid-levels.
The University of Oregon model was also based on a projected number of visits by each
member of the population. This was deemed unrealistic because a certain portion of the
population is not going to use healthcare services under any circumstances. This model
may be run using one of two scenarios. One scenario assumes 65% of all visits will be to
primary care physicians and another that assumes 80% of visits will be to primary care
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physicians. The University of Oregon model also estimated the number of inpatients
annually and the number of inpatient procedures annually. The University of Oregon
model required input by sex and age group, so included factors beyond just population in
the calculations. This model does not include mid-level providers in its projections.
Estimates were also generated for mid-level providers, oral health providers, and
behavioral health providers. These were based on the usage rates from all 20 community
health centers in Alaska. The population served by the community health centers is
68,598. While not ideal, these were the only figures which could be located that provided
the necessary information to calculate needed providers. Making decisions based on the
community health centers’ usage was rejected because the population seen by the centers
was not deemed to be representative of the general population.
Using these different models yielded quite different projections in the number of
providers needed to serve a certain population. This was due to differences in their
underlying assumptions about the number of visits a provider can handle annually. For
example, the University of Oregon model uses figures from the American Medical
Association and assumes one primary care physician can have 4,900 visits annually. This
is very similar to the number of visits for a primary care provider that the Medical Group
Management Association (MGMA) assumes. These figures are also in line with the UDS
(Uniform Data System) figures which are collected by HHS/HRSA/Bureau of Primary
Care for Community Health Centers, Migrant Health Centers, Health Care for the
Homeless programs, Public Housing Primary Care programs, and any section 330 funded
Health Center.
Another method examined was to review the number of providers per 100,000 population
by type of provider. For some types of providers this information was located for Alaska,
but for other providers, only the national level of providers could be located. Even
knowing the number of a certain type of provider in Alaska was not all that informative
for these purposes since this inquiry needed to know how many providers are practicing
in the Mat-Su Borough.
Finally, the group moved toward acceptance of a model based on the panel size a
provider can treat. This is a method that uses a ratio of population to provider in order to
determine need. A number of suggested panel sizes were considered, such as those
recommended by the American Medical Association and others. This was a preferable
method of projecting provider need. Using the CDC’s usage data assumes that every
single person will use as much healthcare in the future as those who have already used
healthcare in the past did, which is not a sound assumption.
Ultimately, the assumption of providers needed per population is based on the ratios used
by the Southcentral Foundation. Using ratios that are currently being employed by
Alaskan providers felt like a better fit and stronger assumption than using nationwide
figures. Southcentral Foundation’s ratio is 1 provider to 2,000 population for primary
care physicians and dentists. This ratio was the starting point, but was not used for all
communities because the core area, the slightly-less-dense collar area surrounding the
core, and the outlying areas are so different. It would not be appropriate to use one
model for everything.
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Consequently, the 1:2,000 ratio was adjusted for outlying areas of the borough based on
extenuating circumstances such as low population density. Providers in rural areas
typically see fewer patients because they provide more aspects of the patient’s care. For
example, if the patient needs x-rays the provider is the one who takes the x-ray unlike in a
more urban setting where the patient would be sent to someone else for the x-ray. Rural
providers can spend between a half hour and an hour with a patient, instead of ten to
fifteen minutes as in urban areas.
Projected need was calculated using the starting point of 1:2,000 and then modifying that
ratio to meet the unique needs of each area. The following ratios were used.
Table 49 Provider to Population Ratios
Sub-regions
Service Areas
Panel Size
Core
Wasilla-Palmer
1:2,000
Collar
Old Glenn Hwy
Knik Goosebay Rd
South Parks Hwy
1:1,500
Rural
Glenn Hwy South
Glenn Hwy North
Upper Susitna Valley
Off Road
1:1,200
The base ratio for behavioral health was 1:3,600. This ratio was used for all service
areas, since behavioral health providers do not face the same issues in terms of additional
work in rural areas. It should be noted that the ratios used by Southcentral Foundation do
not include mid-level providers. This plan considers mid-level providers a very
important part of the system of care. The only reason they were not part of the
calculation about how many providers may be needed to meet current and future needs is
that no models could be found which incorporated mid-levels and had sound
assumptions. Southcentral Foundation and other providers have substantially lower
ratios for mid-level providers. The ratio is in the neighborhood of 1:600-800.
PRIMARY CARE PROJECTED DEMAND AND GAP IN SERVICES
The existing primary care providers in the borough are comprised of a mix of physicians
and mid-level providers. The vast majority of the existing primary care providers are
currently gathered in the Core Area. There are more mid-level providers than physicians
outside the Core Area. The fastest growing areas within the borough are just outside the
Core Area in the Knik Goosebay Road and South Parks Highway service areas. There
are currently a handful of providers in these areas; the number is sure to increase as the
population expands. As mentioned, the model only includes physicians because no
appropriate model could be found that incorporated both. The plan values mid-level
providers and regards them as a crucial piece of the healthcare system.
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The table below shows the projected need for primary care physicians by service area for
2004, 2010, and 2015. This is based on estimated population and the varying panel sizes
discussed above.
Table 50 Current Primary Care Providers and Projected Need
Service Area
Number of
Current
Providers*
Primary Care Physicians Needed
2004
2010
2015
40
16.17
20.34
24.62
Old Glenn Hwy
0
3.21
3.82
4.40
Knik Goosebay Rd
0
6.29
9.53
13.46
South Parks Hwy
0
6.82
8.75
10.78
Glenn Hwy South
0
1.83
2.12
2.39
Glenn Hwy North
0
0.30
0.34
0.38
Upper Susitna Valley
2
3.54
4.07
4.56
Off Road
0
0.09
0.06
0.04
42
38.25
49.03
60.63
Core Area
Total
*Includes primary care, pediatricians, OB/GYN, and internists.
1) The number of current providers reflects the number of actual providers in the area,
not the level of full time equivalents (FTE). Not all current providers are working full
time. Projected need is for FTEs.
2) Projected providers assumes each service area continues to experience the same rate of
population growth for the upcoming ten years as it has for the previous five years.
Table 51 Mat-Su Borough Population Projections: 2004 to 2015
2004*
Population
Projected
2010
Projected
2015
3.9%
32,336
40,675
49,245
Old Glenn Hwy
2.9%
4,822
5,724
6,604
Knik Goosebay Rd
7.2%
9,439
14,288
20,185
South Parks Hwy
4.3%
10,225
13,128
16,167
Glenn Hwy South
2.5%
2,196
2,542
2,872
Glenn Hwy North
2.1%
365
412
456
Upper Susitna Valley
2.3%
4,250
4,878
5,471
-6.7%
112
74
52
Average Annual
Population Growth
(2000-2004)
Core Area
Service Area
Off Road
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3) One additional consideration when thinking about the required providers for the MatSu Borough is to consider the impact of tourists. For example, the Upper Susitna Valley
has over 400,000 people pass through who visit Denali National Park each summer.
Many tourists drive out the Glenn Highway to Glacier View. Other communities like
Lake Louise more than double in size in the summer as people come to their summer
cabins. These and other areas in the borough also see sizable numbers of people visiting
to snow machine.
ORAL HEALTHCARE PROJECTED DEMAND AND GAP IN SERVICES
Oral healthcare providers are even more concentrated in the Core Area than are primary
care providers. With primary care providers there are mid-levels in the South Parks Hwy,
Glenn Hwy South, Glenn Hwy North, and Upper Susitna Valley service areas. Since
there are no equivalent type dental providers, the dentists listed below represent all access
to dental care available in the Mat-Su Borough.
As mentioned in the previous section, the number of current providers may exaggerate
the availability of care, since all these dentists may not be working full time. As with
primary care, the need for providers is based on continued population growth at the rate
experienced in the recent past. Oral health providers are not nearly as impacted by the
tourist influx as primary care providers.
Table 52 Current Practicing Dentists and Projected Need: 2004 to 2015
Service Area
Core Area
Number of
Current Providers
2004
Dentists Needed
2010
2015
34
16.17
20.34
24.62
Old Glenn Hwy
0
3.21
3.82
4.40
Knik Goosebay Rd
0
6.29
9.53
13.46
South Parks Hwy
0
6.82
8.75
10.78
Glenn Hwy South
0
1.83
2.12
2.39
Glenn Hwy North
0
0.30
0.34
0.38
Upper Susitna Valley
1
3.54
4.07
4.56
Off Road
0
0.09
0.06
0.04
35
38.25
49.03
60.63
Total
BEHAVIORAL HEALTHCARE PROJECTED DEMAND AND GAP IN SERVICES
Behavioral health is the accepted terminology for the field that encompasses mental
health services and substance abuse treatment. As noted above, the ratio of behavioral
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health providers to population has not been adjusted for different service areas. The ratio
is the same for all service areas because there are no additional tests for behavioral health
providers to run in rural areas that urban providers would have support staff to
administer. The ratio is 1:3,600.
Behavioral health providers offer a unique challenge in determining if need has been met
because the providers are not all interchangeable. While primary care providers, be they
physicians or mid-levels, offer many of the same services, some behavioral health
providers are trained in substance abuse treatment while others are more qualified to
handle mental illness.
As mentioned in the previous section, the number of current providers may exaggerate
the availability of care, since all these providers may not be working full time. As with
primary care, the need for providers is based on continued population growth at the rate
experienced in the recent past. Behavioral health providers are not nearly as impacted by
the tourist influx as primary care providers.
Table 53 Current Behavioral Health Professionals and Projected Need: 2004 to 2015
Service Area
Core Area
Number of
Current Providers
Behavioral Health Providers Needed
2004
2010
2015
25
8.98
11.30
13.68
Old Glenn Hwy
0
1.34
1.59
1.83
Knik Goosebay Rd
0
2.62
3.97
5.61
South Parks Hwy
0
2.84
3.65
4.49
Glenn Hwy South
0
0.61
0.71
0.80
Glenn Hwy North
0
0.10
0.11
0.13
Upper Susitna Valley
1
1.18
1.36
1.52
Off Road
0
0.03
0.02
0.01
26
17.70
22.71
28.07
Total
EMERGENCY MEDICAL SERVICES PROJECTED DEMAND AND GAP IN SERVICES
The Borough’s EMS system currently has no full-time employees; in fiscal year 2004 the
system made over 5,700 runs. It is very difficult to train and maintain “volunteer” EMS
personnel and expect to develop the experience and knowledge level equal to a paid, fulltime workforce. The higher level training and certification requires a greater time
commitment from the volunteer personnel; a commitment most people cannot make.
There are five levels of EMS personnel from Emergency Trauma Tech (ETT) at the low
end to paramedic at the high end. To be an ETT requires 40 hours of training. The next
level of training (EMT) requires 120 hours of training. The middle level, EMT 2, is the
first level able to start an IV and create an airway.
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Currently there is one location in the entire borough that is staffed continuously and those
staff are not hired as full-time employees. While there is borough-wide EMS coverage, it
is provided through a web of coverage woven with volunteers and through agreements
with other agencies such as the Dept. of Forestry, the State Troopers, and the military. In
an ideal world the borough would like to have continuous paramedic coverage in the core
area and EMT3 coverage everywhere else in the borough. This is extremely costly
because of the number of personnel required to enable continuous coverage. Night shifts
are difficult to staff. The borough provides the training, equipment, and physician
supervision to the EMS program.
In the community forums several EMS volunteers noted the difficulty having volunteers
lined up to provide continuous coverage. This is especially difficult during holidays and
during the summer when many people are seasonally employed (or enjoying the
weather).
Other EMS issues raised at the community forums were payment issues related to
ambulance trips. One problem was seniors and others with no transportation calling for
an ambulance when they did not require one, but needed a ride to a medical appointment
or to see a provider in a non-emergency situation. This problem was mentioned more
frequently than the second problem, which was people arguing about using the
ambulance due to fear of the cost. Primarily this was mentioned in a context where
someone else called 911 for the patient, but then the patient did not want to use the
service. EMS providers mentioned that many people who do eventually call for an
ambulance should have gone to the hospital sooner, but due to cost, waited until they
were very sick and clearly could not avoid being hospitalized.
Other problems for the EMS program are that, with few exceptions, once a patient is
picked up by EMS that person must be taken to the hospital. Depending on where in the
borough they started it can take over four hours for one run—to pick up patient, take
them to the hospital, return to the community, return the ambulance to ready condition,
and complete all necessary paperwork. This is a huge amount of time for volunteers, as
well as time that ambulance is not available to others.
Table 54 EMS Resources by Service Area
58
Service Area
Number of Current Units
Core Area
6 ambulances & 1 Medic One (Wasilla, Palmer)
Old Glenn Hwy
1 ambulance (Butte)
Knik Goosebay Rd
None
South Parks Hwy
3 winter/4 summer ambulances (Big Lake, Houston, Meadow Lakes)
Glenn Hwy South
1 ambulance (Sutton)
Glenn Hwy North
1 ambulance & 1 non-transport first responder (Glacier View, Lake Louise)
Upper Susitna Valley
4 ambulances (Talkeetna, Trapper Creek, Willow, Y)
Off Road
None
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Appendices
APPENDIX A: KEY INFORMANT INTERVIEW QUESTIONNAIRRE
1) What prevents people in the borough from getting the health care they need? Is that
true for the urban and rural areas of the borough?
2) What are the health care challenges facing the Mat-Su? Are they the same for the
urban and rural areas of the borough?
3) Among the issues you raised in the first two questions, what do you think is the biggest
issue preventing all Mat-Su residents from getting the health care they need right here in
the borough? Is that issue the same for the urban and rural areas of the borough?
4) What are the strengths of the local health care services? Is there anything that’s great
that shouldn’t be changed? Are the strengths different in urban versus rural areas of the
borough?
5) What do you think could be done to improve healthcare services in the borough?
Would that be the same thing in all areas of the borough?
6) Are there other health care concerns/issues? Or other things you’d like to add?
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APPENDIX B: DATA FROM KEY INFORMANT INTERVIEWS
Question 1
What prevents people in the borough from getting the health care they need? Is that true
for the urban and rural areas of the borough? (Nearly all respondents gave more than one
answer.)
Response
Number
High cost/no money/no insurance
30
Lack of transportation
18
Distance
10
Too few providers to serve population
8
Lack of providers accepting Medicare or Medicaid
7
Lack of education re: importance of health care
2
Lack of access to preventive care
2
Providers’ hours not convenient
1
No idea
1
High cost/no money/no insurance
60
•
They send a lot of people to Anchorage or to Talkeetna because those are sliding fee scale clinics.
•
Cost, lack of insurance. The issue is the same across the whole country, so it’s not something that
is just affecting the rural or urban area of the borough.
•
Economics. The economic condition of many people is just survival, so health care is out of the
question unless it is an emergency. The increased cost for people out of the core areas to get to
services in the core area make it that much harder. Especially for the elderly and for kids.
•
The differences between the rural and urban areas are that the Core area has transportation-MASCOT, taxis, Medicaid will pay for transportation for people. The rural areas are poorer and
people only have temporary jobs or seasonal jobs. For people working in the summer they have to
make hay while the sun shines and they don’t have time for health care in the summer. They have
to make money while they can.
•
Another issue is the cost of medication. Much of it is not covered by Medicaid or Medicare, so if
people don’t have private insurance they can’t afford their medications.
•
The lack of health insurance type programs is a major barrier to care. So much of the economy in
Mat-Su is a service economy. The jobs might pay living wages, but there is no health insurance
offered or if it is than it eats up such a share of the pay that the job doesn’t pay a living wage
anymore.
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Lack of transportation
•
If they don’t have transportation they have no access.
•
People have to understand that the poor have transportation issues, primarily they have no
vehicles.
•
Definitely transportation is an issue. People don’t have gas money and they can’t track down the
bus and figure that out. Their clients are very low income. $20 to get to an appointment is too
much.
•
Transportation to and from treatment facilities is a problem too. There are elderly people who
can’t drive anymore. Some of them are afraid to drive to Anchorage even if they do still drive.
Anchorage is too busy and there’s too much traffic; it is scary and confusing so they don’t go.
Distance
•
It is the same urban and rural. Although in the rural areas, distance is an issue too. She actually
thinks that the people who live further out are better about not whining about driving. They drive
a lot and are used to it. Doing anything involves driving, so it’s not big deal. The people further
out are more motivated--she doesn’t have to nag people in Glacier View for immunizations. She
thinks people who live so far out are less likely to use entitlement programs because they are
difficult to use when you live far out. She thinks people are little less poor who live that far out.
•
The geographic location is another barrier. The length of time it takes to travel to Palmer is
prohibitive for a lot of people.
Too few providers to serve population
•
Availability is also an issue--the lack of providers. For example, he needs to see the dentist right
now, but has to wait a month for an appointment.
•
There are limited offerings versus what’s available in Anchorage. There aren’t enough
pediatricians or dermatologists. There is no psychiatric care, especially none focused on
adolescents.
•
The second issue is the availability of specific services closer to home. Anchorage has a lot more
to offer. In Alaska in general, due to its small population, adequate health care is limited.
Lack of providers accepting Medicare or Medicaid
•
There is limited access for the growing number of Medicare patients. It is hard to find specialists
who take Medicare.
•
There are problems with Medicaid funding, especially because not many preventative services are
covered. Also, while there aren’t that many providers who refuse Medicaid entirely, many limit
the percentage of their Medicaid patients which makes it difficult for people to find providers.
Question 2
What are the health care challenges facing the Mat-Su? Are they the same for the urban
and rural areas of the borough? (Nearly all respondents gave more than one answer.)
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Response
Number
High cost/no money/no insurance
17
Too few providers to serve population
12
No prevention available or no understanding of importance
9
Lack of transportation
9
Continued population growth in Mat-Su
9
Distance
7
Too few behavioral health providers and services
7
Lack of providers accepting Medicare or Medicaid
4
Lack of borough health powers
2
Providers’ hours not convenient
2
High cost/no money/no insurance
•
She thinks the Valley has pretty good comprehensive care with a lot of services offered, but for so
many people who don’t have the ability to pay for those services, it doesn’t matter what is
available. So many people don’t have insurance and for those who do, even the 20% they have to
pay can be prohibitively expensive. It is a hard situation.
•
Cost is the issue. People can’t afford to go to the doctor, so problems go from minor to major.
For many people the issue is not just seeing the doctor, but also getting the medication afterwards.
Even if they can afford the appointment, they can’t afford the medication too.
•
Affordability is a huge issue.
•
People don’t have insurance. There are a lot of people whose children are covered by the Denali
Kid Care and Medicaid, but there are lots of new people who don’t know about Denali Kid Care.
Health care is so expensive, people are shut out.
•
Cost is such an issue, especially for dental care. There are no low cost dentists. Unless people
have medical benefits, they can’t afford to get care. There are so many non-union construction
workers and self-employed people and seasonal workers that have no insurance.
•
She refers people to Anchorage to Neighborhood Health, but they have no transportation and no
money. Many of the Russian immigrants also have no one to translate.
Too few providers to serve population
62
•
Availability--the number of providers and the location of providers (all in the core area).
•
Many specialties are lacking in the Valley. The population is aging and there and lots and lots of
kids. There aren’t enough pediatricians or internists.
•
The shortage of medical professionals--doctors and nurses.
•
The growing population and the limited number of providers is going to become a bigger problem.
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Mat-Su Primary Healthcare Plan 2005-2015
•
It is hard to get providers, especially dentists, to come to the rural areas. There are not enough
people to take advantage of a provider to keep them in business. There might be enough people to
make it work, but by the time people hear about it the provider has had to leave.
No prevention available or no understanding of importance
•
Another problem is that people wait until something is an emergency and don’t go for care before
the problem is serious. The biggest challenge is the lack of preventative care. Since people don’t
have funds to go for prevention, they don’t get it.
•
There is not enough education regarding the importance of prevention and the acceptance of the
need for health care are challenges.
•
There aren’t enough prevention providers. There need to be more.
•
He has two big worries. 1) There aren’t enough resources to meet prevention needs now. It would
be a huge job to meet those needs now. So if the population really grows the way they have
predicted, it looks like meeting that need will become impossible.
Lack of transportation
•
People have been using the ambulance as transportation to medical appointments because they
have no other transportation options.
•
Transportation is an issue for a fair number of rural residents in the borough. Many people don’t
have a vehicle. They might have a snowmachine they can take to the road, but they don’t have a
vehicle at the road. There is very little public transportation in the borough and that thwarts
people’s efforts to get around. There are a lot of people who live off the road system scattered
throughout the borough. There are a lot of people along the Glenn Highway, out toward
Glenallen.
•
She said MASCOT service level has gone up and down, but that they have never served the
communities on the Glenn. They are currently making runs to Willow and Talkeetna.
•
A challenge for those in the senior population is their ability to get there. Many of them don’t
drive, so it doesn’t matter what services are available since they can’t get to them. One of her
residents needed dialysis three days a week, but couldn’t go. She didn’t drive and couldn’t keep
asking friends to take her and then wait for hours till she was ready to go home. There is service
with MASCOT, but it is limited. If people don’t have family, friends, neighbors, or church
members who will take care of them and give them rides, they will be out of luck.
Continued population growth in Mat-Su
•
The major population influx is the big thing that’s going to challenge the health care system.
There could be 100,000 people in the Valley before too long and there is no infrastructure to
handle that situation. Anchorage is out of room to build, so those people are coming to the Valley
either on the bridge over the Knik Arm or on the four lane highway from Anchorage, but it’s
inevitable.
•
The growing population and the limited number of providers is going to become a bigger problem.
•
The growth. Mat-Su is the fastest growing area in the state.
Distance
•
She feels like the same issues are present throughout the borough, but that the urban area will
benefit sooner from any improvements. She feels like improvements will take longer to get to the
rural areas, especially on the Glenn. She is worried than once the bulk of people in urban area
have their needs addressed the urgency to do something will abate and the situation on the Glenn
will never be addressed.
•
Distance is the big issue. Especially when it’s an emergency; it is hard to get to town.
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Too few behavioral health providers and services
•
Substance abuse is a huge problem and the root cause of most other problems. Depression is
under-diagnosed throughout the borough. Mental health issues in general are under-diagnosed
throughout the borough.
•
Mental health services are really lacking. Counseling, especially for children is almost entirely
absent and there is no one who takes Denali Kid Care or Medicaid. It can take up to four months
to get an appointment for a kid. There is a lot of counseling in the Valley, but they don’t take
Denali Kid Care and Medicaid. There is a big need for more pediatric psychiatric facilities.
•
Mental health is a huge issue and there are not a lot of resources.
Question 3
Among the issues you raised in the first two questions, what do you think is the biggest
issue preventing all Mat-Su residents from getting the health care they need right here in
the borough? Is that issue the same for the urban and rural areas of the borough? (Many
respondents gave more than one answer.)
Response
Number
High cost/no money/no insurance
31
Lack of education about health issues/importance of prevention
8
Lack of transportation
6
Distance
4
Too few providers to serve population
3
Too few behavioral health providers and services
3
Lack of providers accepting Medicare or Medicaid
3
High cost/no money/no insurance
64
•
Money is the biggest issue. People don’t have insurance, but they work so they don’t qualify for
any programs. People can’t afford it and so end up just not getting health care.
•
The financial--people just don’t know where to turn.
•
Cost is the biggest issue. Especially because so many people in their community are retired.
•
Affordability is the issue, especially because Alaskans are an independent group and feel that the
money could be put somewhere else. People don’t realize that down the road we are really going
to need these services, people are taking too short-sighted a view of the situation.
•
Cost--people can’t afford it so they don’t go anywhere.
•
There are fewer employers providing insurance than there used to be. It used to be easier to afford
insurance on your own. Now, fewer employers offer it and the ones who do ask for more of a
contribution from the employees. Those people who don’t get insurance from their employer
can’t afford to buy it on their own.
•
The lack of insurance-there is a huge number of self-employed people in the Valley. People are
carpenters and seasonal workers who don’t have insurance. Thirty percent of their patients are
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Mat-Su Primary Healthcare Plan 2005-2015
self-pay. Denali Kid Care has helped the kids, but the adults are stuck. They work so make too
much for Medicaid, but not enough to buy insurance. The area is still growing, but is rural enough
that it has lots of small businesses and those folks can’t afford insurance.
Lack of education about health issues/importance of prevention
•
A lack of knowledge by people that they need to go to the doctor.
•
There is no clearinghouse where people can get information on where to get services for physical
health, mental health needs, or dental issues. While there are providers in the Valley, people don’t
know where to turn.
•
There is no preventative care. Education about the value of prevention is an issue and the money
to pay for prevention is the other issue.
•
Not enough access to prevention. The hospitals in Anchorage do more prevention. Valley
Hospital doesn’t do enough; they have one health fair a year or something.
•
We have to change how people get into health care. They don’t go in until they are sick, but need
to go earlier for prevention.
•
People don’t know where to go. It is hard for her to keep up with the changes. Providers come
and go; makes it hard to track and hard for people to get good consistency of care. People need
more education and a directory would help. She stressed that it shouldn’t just be a directory of
Valley Hospital related people, but should include everyone.
•
Younger people--under 30--tend to not think going to the doctor is that important. They are still
young enough they think they’ll be fine. She also thinks people don’t want to come to the core
area or to town, especially for preventive stuff when they feel fine. And especially people who
live out in the woods.
Lack of transportation
•
Transportation and inclination [are the biggest issues]. Transportation is such a big issue even
though there is a clinic in the area because people have “Talkeetna cars”--cars you could drive
around the area, but not to Wasilla.
•
There is no transportation for people to get to providers in Anchorage who must for coverage.
•
Transportation is the biggest issue. People who just can’t figure out how to use MASCOT or
other things. The issues are really the same all across the borough.
Question 4
What are the strengths of the local health care services? Is there anything that’s great that
shouldn’t be changed? Are the strengths different in urban versus rural areas of the
borough? (Nearly all respondents gave more than one answer.)
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Response
Number
New hospital
13
Providers in area good, skilled, caring, committed
12
Increase in number of providers and specialists
12
Sunshine Clinic
12
Collaboration between providers
7
EMS
6
None
1
No comment
1
New hospital
•
He was just at Valley Hospital for a kidney issue and cancer and he thinks they have talented
physicians and great nurses. He hopes that carries over into the new hospital. [I asked him what
his concern about the new hospital was.] He worries that because it is so big it will lose the local
feeling and the family flavor will be gone.
•
The new hospital will have more services which is good (they are going to have cardiac care).
•
Valley Hospital is a good hospital for most things, although they don’t have the specialists like
Providence does. With the new hospital there might be more specialists.
•
While he doesn’t personally know the new management of the Valley Hospital, he thinks they are
committed to providing good services and that they really care about folks.
•
The area is improving, the new hospital is a good thing.
Providers in area good, skilled, caring, committed
•
Physicians in the community are fairly interested in the community and in providing high quality
care and being active with the hospital. In the process of trying to meet the needs there are some
interesting collaborations. She works with Children’s Place which is a center for abused and
neglected children. And there have been mergers and collaborations to meet the needs of the
community. She thinks MAP is a good thing; it helps them get the most out of limited resources.
•
The providers in the Valley know the patients well and that’s a real strength.
•
They get excellent providers who are more than willing to work with people on payment issues.
The providers offer excellent care, once people get to the services.
•
There are some good providers and many will work with patients to get a payment plan that works
for them.
Increase in number of providers and specialists
66
•
She feels it is good that things are improving; more variety and specialties is a good thing.
•
Southcentral Foundation has moved to the Valley which is a real strength for Alaska Natives.
•
She was on the phone today with a specialist. It is a good development to have more specialists in
the Valley.
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•
There are a lot of different options now. There are physicians, P.A.s, nurse practitioners,
specialists, D.O.s, chiropractors, naturopaths. People can find whatever service they are looking
for. She thinks there is a lot of tolerance of non-physician providers by physicians.
•
He views Chickaloon as up and coming. They are trying to expand and are getting bigger all the
time.
•
The increase in the availability of specialty care is good. There is a dialysis center now, some
cancer treatments are available in the Valley and other specialty are moving out. She thinks more
will come as people continue to move out to the Valley.
Sunshine Clinic
•
She agreed that Sunshine was wonderful and has made all the difference. There used to be
nothing in the Upper Su area and now they have lots of services and a private doctor in town too.
•
Sunshine is doing a good job with outreach, they have expended and now have dental. They have
the sliding fee scale, but she thinks people don’t know that.
•
All the expanding that Sunshine has done is excellent--getting a dentist and social worker is good.
Plus getting services in Willow is good too.
•
Sunshine Clinic is fantastic. All the providers are very professional and they are not just worried
about what they can do for you now, but also what they can do for you in the future. However,
they just don’t have all the services that the area needs.
•
He thinks Sunshine is a great asset for the Upper Valley and even an asset for the borough as an
example of what might be done.
Collaboration between providers
•
The awareness of the issues and the willingness by providers and agencies to address the needs.
The health care community in the borough is very pro-active. They are trying to meet the needs.
[I asked her who they were.] She said Southcentral, Valley Hospital, the private providers, etc.
•
The ability to collaborate and work together is a big asset. He thinks MAP is a great thing for
meeting the needs of the borough. Agency representatives can come together and identify the
gaps and figure out how to fill the gaps. People are working to fill the gaps and meet the
community’s needs.
•
The Valley is in a fascinating, young state of collaboration and coordination between providers.
The level of collaboration is so much better than it is in Anchorage.
EMS
•
EMS is the biggest strength. They are well-trained, quick to respond. The more rural the
area, the better the EMS people need to be. In urban areas, the EMS only have to care for you
for a few minutes. In the outlying areas they have to keep you alive for an hour or more.
•
The EMS people are fascinating. Last week they had a snowmachiner who tried to jump a
ravine and didn’t make it and broke his back. They work miracles. They are really
exceptional. On a regular basis they go miles and miles out into the woods to rescue people.
Half the time the Troopers are able to get to people because they go with the EMS folks. He
is in awe of them and thinks they are fascinating.
Question 5
What do you think could be done to improve healthcare services in the borough? Would
that be the same thing in all areas of the borough? (Nearly all respondents gave more than
one answer.)
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Response
Number
Improve access to care for those unable to afford care
19
Increase the number of providers available to serve population
11
Obtain borough health powers or improve health planning
9
Increase availability of behavioral health providers and services
9
Improve public transportation
8
Improve communication about existing services and financial help
6
Increase prevention available and understanding of its importance
6
Increase the number of providers accepting Medicare or Medicaid
4
People are doing everything they can
1
Improved EMS coverage
1
Improve access to care for those unable to afford care
•
Someone needs to figure out ways to have options for uninsured and under-insured to get care.
They need to remove the barriers that keep people from getting care and use the existing resources
in the best possible way.
•
It would be nice to get one or even two 330 clinics to help those who need the sliding fee scale. It
would be really nice to have an urgent care facility that was sliding fee scale. The whole health
care system is too money and insurance focused. There are no HMOs up here, but maybe having
one would be cheaper. There have been problems with HMOs, but they do keep costs down.
•
Further diffusion of available, affordable health care (e.g., not all in Talkeetna). It is great that
they have Sunshine, but there needs to be at least one additional clinic in Wasilla and perhaps
another clinic on the other side of the core area, with a satellite clinic further out the Glenn, maybe
in Chickaloon.
•
A community health center is what is really needed. He knows Behavioral Health of Mat-Su
applied and hopes they get it as that would really help. He thinks it would be good for a local
agency to get the grant because it will help if community members know the agency. It would get
used more than if Providence came up and opened the clinic.
•
Getting more 330 clinics is a real priority.
•
More money, emphasize that more money is needed to meet these needs. And more facilities on
the highway between Wasilla and Fairbanks.
•
There needs to be either more employers providing insurance or a state plan to provide insurance.
There aren’t many Alaska Natives in the area, so almost everyone is without coverage.
Increase the number of providers available to serve population
68
•
He is working to get a health care training center for the state in Mat-Su. The state needs to
address the issue of the lack of providers.
•
More providers need to be recruited to give people more choices.
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Mat-Su Primary Healthcare Plan 2005-2015
•
They are trying to get a nursing program going at the Mat-Su College to meet some of the needs.
•
Recruiting more providers to the area, especially pediatricians, maybe through the new hospital.
•
Another issue is that there are not enough general practitioners--the need is huge relative to the
number of providers.
Obtain borough health powers or improve health planning
•
There are also funding sources the borough could tap if they had health powers. There are grants
and other programs that could be accessed if there were health powers. Right now their share of
the block grant is going to Anchorage because they can’t get it without health powers.
•
In the next ten to twenty years in Alaska the boroughs should start to assume some responsibility
for health. But he doesn’t think the borough or the population is ready yet. Mat-Su is not getting
their fair share of state resources per capita. As it continues to grow, the situation will only get
worse and worse. At some point people will just start to recognize and think about it. John Q.
Public will see that the unorganized areas have higher incomes, but aren’t being taxed the way
Mat-Su residents are. Mat-Su has lower per capita income than many other places in the state.
•
The borough needs to be involved in health planning. They are resisting it for some reason. If
they want to have good quality of life to attract new jobs they need to work to make sure there is
adequate health care. They only need one professional person, a health planner, so that someone
is looking 20 years down the road. Right now it is all just finger-in-the-dike reactions to current
issues and no one is taking the long view. They have enough health powers to do that. They can’t
regulate anything or impose sanctions on anybody for failure to adhere to regulations, but they
could have a planner. They have a planning department already, they should just add a health
planner.
Increase availability of behavioral health providers and services
•
More specialist services. For example, all people with mental health issues that require in-patient
treatment must get on a waiting list and then go to Anchorage when there is finally room.
Substance abuse is an issue. There is limited in-patient treatment in the Valley and no detox.
•
Substance abuse services are limited; Nugen’s has residential and outpatient. Mental health
services are lacking. People still must go to API. There is no place in the Valley to handle a
mental health crisis.
Improve public transportation
•
If there was transportation--either shuttle or bus service or something, both within the Talkeetna
area and down to Wasilla that would be huge.
•
They need to get more transportation, even if MASCOT just came up one day a week, that would
help. People could schedule appointments in town for that day. Basically people in their area feel
abandoned. People in the core area don’t even remember that there are people outside Wasilla and
Palmer. Whenever they plan to try and fix problems, it is only about fixing it in Wasilla and
Palmer.
•
Transportation. The delivery of services needs to improve. It doesn’t matter if there are the best
services in the world if people can’t get to them.
•
Expanding MASCOT will also help the situation. MASCOT needs to expand their service further
out the Glenn. They need to have more runs, currently there are only a few a day.
Improve communication about existing services and financial help
•
She thinks some people perceive barriers where there are not barriers. For example, the doctor
they want to see is not taking new patients, so they assume no one is and don’t call someone else.
She’s not taking new patients, but her colleagues are.
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•
There needs to be more communication about the fact that Sunshine is a sliding fee clinic so
people understand the fee structures. They have good providers so all they need is good
communication maybe some public service announcements would help.
Increase prevention available and understanding of its importance
•
More education is needed about prevention, but she’s not sure how to do that. Healthy people
attend health fairs, so those don’t really work as outreach. She thinks doing stuff through the
schools would be good. And maybe having radio spots.
•
Outreach is needed. There needs to be talk about prevention. Valley Hospital is doing a good job
with injury prevention, especially with drowning prevention, but there needs to be more injury
prevention work. In terms of policy, the borough should close the bars sooner. Having bars open
till 5 A.M., especially when Anchorage’s bars close at 2 A.M. is a bad thing.
Question 6
Are there other health care concerns/issues? Or other things you’d like to add? (Not
everyone responded to this question, but some people had more than one thing to add.)
Response
Number
This data collection effort is a good idea
3
Need to deal with domestic violence
1
Need to deal with disabilities
1
This data collection effort is a good idea
70
•
Information gathering efforts like this are a good step. Things are changing so fast in the Valley
that no one has the complete picture anymore. It is very helpful to assess what’s out there. This
will help better coordinate and integrate services. Then we can figure out where the gaps are and
fill them in.
•
This information gathering that we’re doing is a good thing. We might see solutions that others
haven’t just because we see more of the picture and can link people up. Don’t despise small
beginnings.
•
It is important to do a survey like this. The borough is too diverse, there is a need to share
information.
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APPENDIX C: DATA FROM HOUSEHOLD SURVEY
1) Are you 18 years of age or older?
Valid
Yes
Frequency
400
Percent
100.0
Valid Percent
100.0
Cumulative
Percent
100.0
2) How long have you lived in the Mat-Su area?
Valid
Less than one year
Frequency
8
Percent
2.0
Cumulative
Percent
2.0
Valid Percent
2.0
1-2 years
6
1.5
1.5
3.5
3-5 years
63
15.8
15.8
19.3
6-10 years
78
19.5
19.5
38.8
11-19 years
82
20.5
20.5
59.3
20 years or more
163
40.8
40.8
100.0
Total
400
100.0
100.0
10 years
or less
18
11-19 years
11
20 years
or more
21
36.0%
22.0%
42.0%
100.0%
15
7
28
50
30.0%
14.0%
56.0%
100.0%
47
31
47
125
37.6%
24.8%
37.6%
100.0%
75
33
67
175
42.9%
18.9%
38.3%
100.0%
155
82
163
400
38.8%
20.5%
40.8%
100.0%
Crosstabulation: Geographic
group by How Long Lived in MatSu
Upper Susitna
Count
Glenn Highway
% within
Geographic
group
Count
Core Tracts
% within
Geographic
group
Count
Collar Tracts
% within
Geographic
group
Count
Total
% within
Geographic
group
Count
% within
Geographic
group
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Total
50
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Mat-Su Primary Healthcare Plan 2005-2015
3) How far do you live from the Palmer/Wasilla area?
Frequency
Valid
Live in
Palmer/Wasilla area
Valid Percent
Cumulative
Percent
183
45.8
45.8
45.8
Less than 5 miles
71
17.8
17.8
63.5
6-10 miles
50
12.5
12.5
76.0
11-15 miles
20
5.0
5.0
81.0
16-20 miles
8
2.0
2.0
83.0
21-40 miles
14
3.5
3.5
86.5
41-70 miles
38
9.5
9.5
96.0
71-100 miles
16
4.0
4.0
100.0
400
100.0
100.0
Total
72
Percent
Information Insights, Inc.
Mat-Su Primary Healthcare Plan 2005-2015
4) How frequently do you travel to the Palmer/Wasilla area?
Frequency
Valid
Live in Palmer/Wasilla
area
Less than once a month
Cumulative
Percent
158
39.5
39.6
39.6
9
2.3
2.3
41.9
10
2.5
2.5
44.4
Twice a month
19
4.8
4.8
49.1
1-2 times a week
40
10.0
10.0
59.1
3-4 times a week
28
7.0
7.0
66.2
8
2.0
2.0
68.2
Every day
127
31.8
31.8
100.0
Total
399
99.8
100.0
Blank
1
.3
400
100.0
Total
Crosstabulation: Geographic Group by How
Frequently Travel to Core
Upper Susitna
Count
% within Geographic group
Glenn Highway
Count
% within Geographic group
Core Tracts
Count
% within Geographic group
Collar Tracts
Count
% within Geographic group
Total
Valid Percent
Once a month
5 times a week
Missing
Percent
Count
% within Geographic group
Information Insights, Inc.
Twice a month
or less
29
Once a week
or more/Live in
Core
21
58.0%
42.0%
100.0%
0
50
50
.0%
100.0%
100.0%
3
121
124
2.4%
97.6%
100.0%
6
169
175
3.4%
96.6%
100.0%
38
361
399
9.5%
90.5%
100.0%
Total
50
73
Mat-Su Primary Healthcare Plan 2005-2015
5) Do you or someone in your household have reliable transportation?
Valid
Frequency
8
Percent
2.0
Valid Percent
2.0
Cumulative
Percent
2.0
Yes
392
98.0
98.0
100.0
Total
400
100.0
100.0
No
6) If no, do you or someone in your household lack a ...?
Valid
Missing
Frequency
3
Percent
.8
Valid Percent
37.5
Cumulative
Percent
37.5
Valid driver's license
1
.3
12.5
50.0
Both
1
.3
12.5
62.5
Other
3
.8
37.5
100.0
Total
8
2.0
100.0
Reliable vehicle
Valid skip
Total
•
•
•
74
392
98.0
400
100.0
Too old
Can’t because of medication taking
Take Valley vans
Information Insights, Inc.
Mat-Su Primary Healthcare Plan 2005-2015
7) How many adults live in your household including yourself?
Valid
1 adult
Frequency
77
Percent
19.3
Valid Percent
19.4
Cumulative
Percent
19.4
259
64.8
65.2
84.6
59
14.8
14.9
99.5
100.0
2 adults
3-4 adults
5-6 adults
Missing
2
.5
.5
Total
397
99.3
100.0
Blank
2
.5
Don't know
1
.3
Total
3
.8
400
100.0
Total
Crosstabulation: Geographic
Group by Number of Adults in
Household
Upper Susitna
Count
Glenn Highway
% within
Geographic
group
Count
Core Tracts
% within
Geographic
group
Count
Collar Tracts
% within
Geographic
group
Count
Total
% within
Geographic
group
Count
% within
Geographic
group
Information Insights, Inc.
1 or 2 adults
48
More than 2
adults
2
96.0%
4.0%
100.0%
41
9
50
82.0%
18.0%
100.0%
100
24
124
80.6%
19.4%
100.0%
147
26
173
85.0%
15.0%
100.0%
336
61
397
84.6%
15.4%
100.0%
Total
50
75
Mat-Su Primary Healthcare Plan 2005-2015
8) How many children (under 18 years old) live in your household?
Valid
Frequency
235
Percent
58.8
Valid Percent
59.5
Cumulative
Percent
59.5
1 child
63
15.8
15.9
75.4
2 children
56
14.0
14.2
89.6
3-4 children
35
8.8
8.9
98.5
6
1.5
1.5
100.0
Total
395
98.8
100.0
Blank
4
1.0
Don't know
1
.3
No children
5 or more children
Missing
Total
Total
Crosstabulation: Geographic
Group by Number of Children
Upper Susitna
Count
Glenn Highway
% within
Geographic
group
Count
Core Tracts
% within
Geographic
group
Count
Collar Tracts
% within
Geographic
group
Count
Total
% within
Geographic
group
Count
% within
Geographic
group
76
5
1.3
400
100.0
No children
35
1 or 2 children
12
More than 2
children
2
71.4%
24.5%
4.1%
100.0%
32
13
5
50
64.0%
26.0%
10.0%
100.0%
67
41
14
122
54.9%
33.6%
11.5%
100.0%
101
53
20
174
58.0%
30.5%
11.5%
100.0%
235
119
41
395
59.5%
30.1%
10.4%
100.0%
Total
49
Information Insights, Inc.
Mat-Su Primary Healthcare Plan 2005-2015
9) In what geographic area do you and members of your household
typically obtain your primary physical health care? (First answer)
Valid
Frequency
289
Percent
72.3
Valid Percent
73.7
Cumulative
Percent
73.7
Other area of Mat-Su
32
8.0
8.2
81.9
Anchorage
62
15.5
15.8
97.7
9
2.3
2.3
100.0
100.0
Palmer/Wasilla area
Another location
Total
Missing
392
98.0
Don't know
1
.3
Don't use health care
7
1.8
Total
Total
8
2.0
400
100.0
9) In what geographic area do you and members of your household
typically obtain your primary physical health care? (Second answer)
Valid
Other area of Mat-Su
Percent
.5
Valid Percent
5.4
31
7.8
83.8
89.2
4
1.0
10.8
100.0
100.0
Anchorage
Another location
Total
Missing
No second answer
Total
Crosstabulation: Geographic Group
by Where Primary Care
Upper Susitna
Count
% within Geographic
group
Glenn Highway
Count
% within Geographic
group
Core Tracts
Count
% within Geographic
group
Collar Tracts
Count
% within Geographic
group
Total
Count
% within Geographic
group
Information Insights, Inc.
Cumulative
Percent
5.4
Frequency
2
37
9.3
363
90.8
400
100.0
In Mat-Su
34
Anchorage
10
70.8%
Another
location
Total
4
48
20.8%
8.3%
100.0%
41
7
1
49
83.7%
14.3%
2.0%
100.0%
102
19
2
123
82.9%
15.4%
1.6%
100.0%
144
26
2
172
83.7%
15.1%
1.2%
100.0%
321
62
9
392
81.9%
15.8%
2.3%
100.0%
77
Mat-Su Primary Healthcare Plan 2005-2015
10) What is the main reason you or members of your household leave MatSu for primary physical health care? (First answer)
Frequency
Valid
Valid Percent
Cumulative
Percent
Must for coverage (VA,
etc.)
32
8.0
33.0
33.0
Convenience--already
somewhere else on a
regular basis
16
4.0
16.5
49.5
Think higher quality/more
skilled providers
elsewhere
17
4.3
17.5
67.0
4
1.0
4.1
71.1
100.0
Closest providers not in
Mat-Su
Missing
Percent
Another reason
28
7.0
28.9
Total
97
24.3
100.0
Blank
3
.8
Don't know
1
.3
Valid skip
299
74.8
Total
303
75.8
400
100.0
Total
10) What is the main reason you or members of your household leave MatSu for primary physical health care? (Second answer)
Frequency
Valid
Missing
Cumulative
Percent
1
.3
7.7
7.7
Think higher quality/more
skilled providers
elsewhere
3
.8
23.1
30.8
Closest providers not in
Mat-Su
2
.5
15.4
46.2
Another reason
100.0
7
1.8
53.8
Total
13
3.3
100.0
Blank
2
.5
299
74.8
No second answer
Total
78
Valid Percent
Convenience--already
somewhere else on a
regular basis
Valid skip
Total
Percent
86
21.5
387
96.8
400
100.0
Information Insights, Inc.
Mat-Su Primary Healthcare Plan 2005-2015
11) In what geographic area do you and members of your household
typically obtain your specialist physical health care? (First answer)
Valid
Palmer/Wasilla area
Other area of Mat-Su
Anchorage
Another location
Total
Missing
Frequency
150
Percent
37.5
Valid Percent
43.9
Cumulative
Percent
43.9
8
2.0
2.3
46.2
170
42.5
49.7
95.9
14
3.5
4.1
100.0
100.0
342
85.5
Don't know
10
2.5
Don't use health care
48
12.0
Total
Total
58
14.5
400
100.0
11) In what geographic area do you and members of your household
typically obtain your specialist physical health care? (Second answer)
Valid
Other area of Mat-Su
Anchorage
Another location
Total
Missing
Don't use health care
Frequency
1
Percent
.3
Valid Percent
2.3
Cumulative
Percent
2.3
37
9.3
84.1
86.4
100.0
6
1.5
13.6
44
11.0
100.0
2
.5
No second answer
354
88.5
Total
356
89.0
400
100.0
Total
Information Insights, Inc.
79
Mat-Su Primary Healthcare Plan 2005-2015
Crosstabulation: Geographic
Group by Where Specialist Care
Upper Susitna
Count
Glenn Highway
% within
Geographic
group
Count
Core Tracts
% within
Geographic
group
Count
Collar Tracts
% within
Geographic
group
Count
Total
% within
Geographic
group
Count
% within
Geographic
group
80
In Mat-Su
19
Anchorage
20
44.2%
Another
location
Total
4
43
46.5%
9.3%
100.0%
15
27
1
43
34.9%
62.8%
2.3%
100.0%
54
52
2
108
50.0%
48.1%
1.9%
100.0%
70
71
7
148
47.3%
48.0%
4.7%
100.0%
158
170
14
342
46.2%
49.7%
4.1%
100.0%
Information Insights, Inc.
Mat-Su Primary Healthcare Plan 2005-2015
12) What is the main reason you or members of your household leave MatSu for specialist physical health care? (First answer)
Frequency
Valid
Must for
coverage (VA,
etc.)
Convenience-already
somewhere else
on a regular
basis
Think higher
quality/more
skilled providers
elsewhere
Closest providers
not in Mat-Su
Another reason
Missing
Percent
Valid Percent
38
9.5
18.3
18.3
23
5.8
11.1
29.3
68
17.0
32.7
62.0
40
10.0
19.2
81.3
100.0
39
9.8
18.8
Total
208
52.0
100.0
Blank
5
1.3
Don't know
2
.5
Valid skip
185
46.3
Total
192
48.0
400
100.0
Total
Cumulative
Percent
12) What is the main reason you or members of your household leave MatSu for specialist physical health care? (Second answer)
Frequency
Valid
Missing
Percent
Valid Percent
Cumulative
Percent
Convenience--already
somewhere else on a
regular basis
3
.8
12.0
12.0
Think higher quality/more
skilled providers
elsewhere
4
1.0
16.0
28.0
Closest providers not in
Mat-Su
6
1.5
24.0
52.0
Another reason
12
3.0
48.0
100.0
Total
25
6.3
100.0
Blank
4
1.0
Valid skip
184
46.0
No second answer
187
46.8
Total
375
93.8
400
100.0
Total
Information Insights, Inc.
81
Mat-Su Primary Healthcare Plan 2005-2015
13) In what geographic area do you and members of your household
typically obtain your dental care? (First answer)
Valid
Palmer/Wasilla area
Frequency
295
Percent
73.8
Valid Percent
76.6
Cumulative
Percent
76.6
78.2
Other area of Mat-Su
6
1.5
1.6
Anchorage
67
16.8
17.4
95.6
Another location
17
4.3
4.4
100.0
385
96.3
100.0
2
.5
13
3.3
Total
Missing
Don't know
Don't use health care
Total
Total
15
3.8
400
100.0
13) In what geographic area do you and members of your household
typically obtain your dental care? (Second answer)
Valid
Other area of Mat-Su
Frequency
4
Percent
1.0
Valid Percent
19.0
Cumulative
Percent
19.0
12
3.0
57.1
76.2
100.0
Anchorage
Another location
Total
Missing
Don't use health care
5
1.3
23.8
21
5.3
100.0
2
.5
No second answer
377
94.3
Total
379
94.8
Total
400
100.0
Crosstabulation: Geographic Group by
Where Oral Health Care
Upper Susitna
Count
In Mat-Su
29
Anchorage
15
59.2%
% within Geographic
group
Glenn Highway
Count
% within Geographic
group
Core Tracts
Count
% within Geographic
group
Collar Tracts
Count
% within Geographic
group
Total
Count
% within Geographic
group
82
Another
location
5
Total
49
30.6%
10.2%
100.0%
44
5
1
50
88.0%
10.0%
2.0%
100.0%
92
23
4
119
77.3%
19.3%
3.4%
100.0%
136
24
7
167
81.4%
14.4%
4.2%
100.0%
301
67
17
385
78.2%
17.4%
4.4%
100.0%
Information Insights, Inc.
Mat-Su Primary Healthcare Plan 2005-2015
14) What is the main reason you or members of your household leave MatSu for dental care? (First answer)
Frequency
Valid
Missing
Percent
Valid Percent
Cumulative
Percent
Must for coverage (VA,
etc.)
22
5.5
23.9
23.9
Convenience--already
somewhere else on a
regular basis
20
5.0
21.7
45.7
Think higher quality/more
skilled providers
elsewhere
14
3.5
15.2
60.9
Another reason
36
9.0
39.1
100.0
Total
92
23.0
100.0
Blank
5
1.3
Don't know
1
.3
Valid skip
302
75.5
Total
308
77.0
400
100.0
Total
14) What is the main reason you or members of your household leave MatSu for dental care? (Second answer)
Frequency
Valid
Valid Percent
Cumulative
Percent
Think higher
quality/more skilled
providers elsewhere
1
.3
10.0
10.0
Closest providers not
in Mat-Su
2
.5
20.0
30.0
100.0
Another reason
Missing
Percent
7
1.8
70.0
Total
10
2.5
100.0
Blank
4
1.0
Don't know
1
.3
302
75.5
83
20.8
Valid skip
No second answer
Total
Total
Information Insights, Inc.
390
97.5
400
100.0
83
Mat-Su Primary Healthcare Plan 2005-2015
15) In what geographic area do you and members of your household
typically obtain your behavioral health care (mental health services,
counseling, or substance abuse treatment)? (First answer)
Valid
Palmer/Wasilla area
Other area of Mat-Su
Anchorage
Another location
Total
Missing
Don't know
Percent
25.5
4
1.0
2.9
77.9
28
7.0
20.6
98.5
100.0
2
.5
1.5
136
34.0
100.0
11
2.8
Don't use health care
253
63.3
Total
264
66.0
400
100.0
Total
Valid Percent
75.0
Cumulative
Percent
Frequency
102
75.0
15) In what geographic area do you and members of your household
typically obtain your behavioral health care (mental health services,
counseling, or substance abuse treatment)? (Second answer)
Valid
Missing
Total
84
Anchorage
Frequency
6
Percent
1.5
Valid Percent
75.0
Cumulative
Percent
75.0
100.0
Another location
2
.5
25.0
Total
8
2.0
100.0
Don't know
2
.5
Don't use health care
3
.8
No second answer
387
96.8
Total
392
98.0
400
100.0
Information Insights, Inc.
Mat-Su Primary Healthcare Plan 2005-2015
Crosstabulation: Geographic
Group by Where Behavioral
Health Care
Upper Susitna
Count
Glenn Highway
% within
Geographic
group
Count
Core Tracts
% within
Geographic
group
Count
Collar Tracts
% within
Geographic
group
Count
Total
% within
Geographic
group
Count
% within
Geographic
group
Information Insights, Inc.
In Mat-Su
12
Anchorage
5
70.6%
Another
location
Total
0
17
29.4%
.0%
100.0%
9
0
1
10
90.0%
.0%
10.0%
100.0%
29
9
1
39
74.4%
23.1%
2.6%
100.0%
56
14
0
70
80.0%
20.0%
.0%
100.0%
106
28
2
136
77.9%
20.6%
1.5%
100.0%
85
Mat-Su Primary Healthcare Plan 2005-2015
16) What is the main reason you or members of your household leave MatSu for behavioral health care? (First answer)
Frequency
Valid
Valid Percent
Cumulative
Percent
Must for coverage (VA,
etc.)
11
2.8
33.3
33.3
Convenience--already
somewhere else on a
regular basis
3
.8
9.1
42.4
Think higher quality/more
skilled providers
elsewhere
9
2.3
27.3
69.7
Closest providers not in
Mat-Su
3
.8
9.1
78.8
7
1.8
21.2
100.0
33
8.3
100.0
Another reason
Total
Missing
Percent
Blank
2
.5
Valid skip
365
91.3
Total
367
91.8
400
100.0
Total
16) What is the main reason you or members of your household leave MatSu for behavioral health care? (Second answer)
Frequency
Valid
Missing
Closest providers
not in Mat-Su
1
.3
Another reason
1
Total
2
Blank
Valid skip
No second answer
Total
Total
86
Percent
Cumulative
Percent
Valid Percent
50.0
50.0
.3
50.0
100.0
.5
100.0
1
.3
365
91.3
32
8.0
398
99.5
400
100.0
Information Insights, Inc.
Mat-Su Primary Healthcare Plan 2005-2015
17) In what geographic area do you and members of your household
typically obtain your other health services (physical therapy, x-rays,
prescription drugs, etc.)? (First answer)
Frequency
Valid
Palmer/Wasilla
area
Other area of
Mat-Su
Anchorage
Another location
Total
Missing
Don't know
Don't use health
care
Total
Total
Percent
Valid Percent
Cumulative
Percent
307
76.8
81.2
81.2
9
2.3
2.4
83.6
59
14.8
15.6
99.2
3
.8
.8
100.0
378
94.5
100.0
4
1.0
18
4.5
22
5.5
400
100.0
17) In what geographic area do you and members of your household
typically obtain your other health services (physical therapy, x-rays,
prescription drugs, etc.)? (Second answer)
Valid
Missing
Frequency
7
Percent
1.8
Valid Percent
17.9
Cumulative
Percent
17.9
Anchorage
22
5.5
56.4
74.4
Another location
10
2.5
25.6
100.0
Total
39
9.8
100.0
Other area of Mat-Su
No second answer
Total
Information Insights, Inc.
361
90.3
400
100.0
87
Mat-Su Primary Healthcare Plan 2005-2015
Crosstabulation: Geographic
Group by Where Other Services
Upper Susitna
Count
Glenn Highway
% within
Geographic
group
Count
Core Tracts
% within
Geographic
group
Count
Collar Tracts
% within
Geographic
group
Count
Total
% within
Geographic
group
Count
% within
Geographic
group
88
In Mat-Su
28
Anchorage
16
60.9%
Another
location
Total
2
46
34.8%
4.3%
100.0%
39
9
0
48
81.3%
18.8%
.0%
100.0%
105
13
0
118
89.0%
11.0%
.0%
100.0%
144
21
1
166
86.7%
12.7%
.6%
100.0%
316
59
3
378
83.6%
15.6%
.8%
100.0%
Information Insights, Inc.
Mat-Su Primary Healthcare Plan 2005-2015
18) What is the main reason you or members of your household leave MatSu for other health services? (First answer)
Frequency
Valid
Missing
Must for
coverage (VA,
etc.)
Convenience-already
somewhere else
on a regular
basis
Think higher
quality/more
skilled providers
elsewhere
Closest providers
not in Mat-Su
Percent
Valid Percent
Cumulative
Percent
25
6.3
31.6
31.6
12
3.0
15.2
46.8
10
2.5
12.7
59.5
4
1.0
5.1
64.6
Another reason
28
7.0
35.4
100.0
Total
79
19.8
100.0
Blank
2
.5
Don't know
3
.8
Valid skip
316
79.0
Total
321
80.3
400
100.0
Total
18) What is the main reason you or members of your household leave MatSu for other health services? (Second answer)
Frequency
Valid
Missing
Think higher
quality/more
skilled providers
elsewhere
Closest
providers not in
Mat-Su
Another reason
Percent
Valid Percent
2
.5
33.3
33.3
1
.3
16.7
50.0
100.0
3
.8
50.0
Total
6
1.5
100.0
Blank
2
.5
316
79.0
76
19.0
394
98.5
400
100.0
Valid skip
No second
answer
Total
Total
Information Insights, Inc.
Cumulative
Percent
89
Mat-Su Primary Healthcare Plan 2005-2015
19) Do you and members of your household anticipate using the new Valley
Hospital once it opens?
Valid
Missing
Frequency
48
Percent
12.0
Valid Percent
12.9
Cumulative
Percent
12.9
Yes
323
80.8
87.1
100.0
Total
371
92.8
100.0
29
7.3
400
100.0
No
Don't know
Total
Crosstabulation: Geographic
Group by Use New Valley
Hospital
Upper Susitna
Count
Glenn Highway
% within
Geographic
group
Count
Core Tracts
% within
Geographic
group
Count
Collar Tracts
% within
Geographic
group
Count
Total
% within
Geographic
group
Count
% within
Geographic
group
90
No
Yes
Total
13
33
46
28.3%
71.7%
100.0%
6
38
44
13.6%
86.4%
100.0%
13
103
116
11.2%
88.8%
100.0%
16
149
165
9.7%
90.3%
100.0%
48
323
371
12.9%
87.1%
100.0%
Information Insights, Inc.
Mat-Su Primary Healthcare Plan 2005-2015
20) Do you and members of your household have public or private health
coverage?
Valid
No
Frequency
44
Percent
11.0
Valid Percent
11.1
Cumulative
Percent
11.1
337
84.3
84.9
96.0
16
4.0
4.0
100.0
100.0
Yes
Some yes,
some no
Total
Missing
397
99.3
Blank
2
.5
Don’t know
1
.3
Total
3
.8
400
100.0
Total
Crosstabulation: Geographic
Group by Have Health Coverage
Upper Susitna
Count
Glenn Highway
% within
Geographic
group
Count
Core Tracts
% within
Geographic
group
Count
Collar Tracts
% within
Geographic
group
Count
Total
% within
Geographic
group
Count
% within
Geographic
group
Information Insights, Inc.
39
8
Some yes,
some no
3
78.0%
16.0%
6.0%
100.0%
42
5
2
49
85.7%
10.2%
4.1%
100.0%
109
10
4
123
88.6%
8.1%
3.3%
100.0%
147
21
7
175
84.0%
12.0%
4.0%
100.0%
337
44
16
397
84.9%
11.1%
4.0%
100.0%
Yes
No
Total
50
91
Mat-Su Primary Healthcare Plan 2005-2015
21) If yes, what type of health coverage do you and members of your
household have? (First answer)
Frequency
Valid
Private (Blue
Cross, Atena,
etc.)
Private
(catastrophic only)
Medicare
Medicaid
Veterans'
Administration
Denali Kid Care
Native Health
Service
Other
Missing
Percent
Valid Percent
243
60.8
68.8
68.8
19
4.8
5.4
74.2
30
7.5
8.5
82.7
10
2.5
2.8
85.6
6
1.5
1.7
87.3
12
3.0
3.4
90.7
10
2.5
2.8
93.5
100.0
23
5.8
6.5
Total
353
88.3
100.0
Blank
1
.3
Don't know
Valid skip
Total
Total
Cumulative
Percent
2
.5
44
11.0
47
11.8
400
100.0
21) If yes, what type of health coverage do you and members of your
household have? (Second answer)
Frequency
Valid
.3
1.0
1.0
26
6.5
24.8
25.7
Medicaid
10
2.5
9.5
35.2
7
1.8
6.7
41.9
9
2.3
8.6
50.5
10
2.5
9.5
60.0
20
5.0
19.0
79.0
22
5.5
21.0
100.0
105
26.3
100.0
42
10.5
253
63.3
Total
Valid skip
No second
answer
Total
92
Cumulative
Percent
1
Native Health
Service
Workers'
Compensation
Other
Total
Valid Percent
Private
(catastrophic only)
Medicare
Veterans'
Administration
Denali Kid Care
Missing
Percent
295
73.8
400
100.0
Information Insights, Inc.
Mat-Su Primary Healthcare Plan 2005-2015
Crosstabulation: Geographic
Group by Type of Coverage
Upper Susitna
Count
Glenn Highway
% within
Geographic
group
Count
Core Tracts
% within
Geographic
group
Count
Collar Tracts
% within
Geographic
group
Count
Total
% within
Geographic
group
Count
% within
Geographic
group
Information Insights, Inc.
Private
32
Government
program
Other
Total
8
1
41
78.0%
19.5%
2.4%
100.0%
30
8
6
44
68.2%
18.2%
13.6%
100.0%
85
19
10
114
74.6%
16.7%
8.8%
100.0%
115
33
6
154
74.7%
21.4%
3.9%
100.0%
262
68
23
353
74.2%
19.3%
6.5%
100.0%
93
Mat-Su Primary Healthcare Plan 2005-2015
22) What is the primary reason you and/or members of your household do
not have insurance?
Valid
Cannot afford
Don't qualify for
government
programs
Don't want or
need
Other
Missing
94
Percent
8.8
Valid Percent
64.8
Cumulative
Percent
64.8
4
1.0
7.4
72.2
7
1.8
13.0
85.2
100.0
8
2.0
14.8
Total
54
13.5
100.0
Blank
6
1.5
Don't know
Total
Frequency
35
1
.3
Valid skip
339
84.8
Total
346
86.5
400
100.0
Information Insights, Inc.
Mat-Su Primary Healthcare Plan 2005-2015
23) In the past two years have you or someone in your household used
primary physical health care (including routine preventative
examinations)?
Valid
Missing
Frequency
46
Percent
11.5
Yes
351
87.8
88.4
Total
397
99.3
100.0
Blank
1
.3
Don't know
2
.5
Total
3
.8
400
100.0
No
Total
Crosstabulation: Geographic Group by
Used Primary Care
Upper Susitna
Count
% within Geographic
group
Glenn Highway
Count
% within Geographic
group
Core Tracts
Count
% within Geographic
group
Collar Tracts
Count
% within Geographic
group
Total
Count
% within Geographic
group
Information Insights, Inc.
Valid Percent
11.6
Yes
Cumulative
Percent
11.6
100.0
No
Total
41
9
50
82.0%
18.0%
100.0%
46
4
50
92.0%
8.0%
100.0%
107
18
125
85.6%
14.4%
100.0%
157
15
172
91.3%
8.7%
100.0%
351
46
397
88.4%
11.6%
100.0%
95
Mat-Su Primary Healthcare Plan 2005-2015
24) If no one in your household has used primary physical health care, was
it because you...
Valid
Didn't need it
Frequency
30
Percent
7.5
Valid Percent
75.0
Cumulative
Percent
75.0
4
1.0
10.0
85.0
Had no
coverage for it
Too expensive
1
.3
2.5
87.5
5
1.3
12.5
100.0
Total
40
10.0
100.0
Blank
6
1.5
Don't know
3
.8
Valid skip
351
87.8
Total
360
90.0
400
100.0
Another reason
Missing
Total
25) In the past two years have you or someone in your household used
specialist physical health care?
Valid
Missing
Frequency
144
Percent
36.0
Valid Percent
36.1
Cumulative
Percent
36.1
Yes
255
63.8
63.9
100.0
Total
399
99.8
100.0
Blank
1
.3
400
100.0
No
Total
Crosstabulation: Geographic
Group by Used Specialist Care
Upper Susitna
Count
Glenn Highway
% within
Geographic
group
Count
Core Tracts
% within
Geographic
group
Count
Collar Tracts
% within
Geographic
group
Count
Total
% within
Geographic
group
Count
% within
Geographic
group
96
Yes
No
Total
26
24
50
52.0%
48.0%
100.0%
34
16
50
68.0%
32.0%
100.0%
72
53
125
57.6%
42.4%
100.0%
123
51
174
70.7%
29.3%
100.0%
255
144
399
63.9%
36.1%
100.0%
Information Insights, Inc.
Mat-Su Primary Healthcare Plan 2005-2015
26) If no one in your household has used specialist physical health care,
was it because you...
Valid
Frequency
117
Percent
29.3
Valid Percent
94.4
Cumulative
Percent
94.4
1
.3
.8
95.2
6
1.5
4.8
100.0
124
31.0
100.0
21
5.3
Valid skip
255
63.8
Total
276
69.0
400
100.0
Didn't need it
Too
expensive
Another
reason
Total
Missing
Blank
Total
27) In the past two years have you or someone in your household used
dental health care?
Valid
Missing
Frequency
64
Percent
16.0
Valid Percent
16.1
Cumulative
Percent
16.1
Yes
334
83.5
83.9
100.0
Total
398
99.5
100.0
Blank
2
.5
400
100.0
No
Total
Crosstabulation: Geographic Group
by Used Dental Health Care
Upper Susitna
Count
% within Geographic
group
Glenn Highway
Count
% within Geographic
group
Core Tracts
Count
% within Geographic
group
Collar Tracts
Count
% within Geographic
group
Total
Count
% within Geographic
group
Information Insights, Inc.
Yes
No
Total
36
14
50
72.0%
28.0%
100.0%
44
5
49
89.8%
10.2%
100.0%
106
19
125
84.8%
15.2%
100.0%
148
26
174
85.1%
14.9%
100.0%
334
64
398
83.9%
16.1%
100.0%
97
Mat-Su Primary Healthcare Plan 2005-2015
28) If no one in your household has used dental health care, was it because
you...
Valid
Frequency
36
Percent
9.0
Valid Percent
69.2
Cumulative
Percent
69.2
6
1.5
11.5
80.8
4
1.0
7.7
88.5
6
1.5
11.5
100.0
Total
52
13.0
100.0
Blank
12
3.0
2
.5
Valid skip
334
83.5
Total
348
87.0
400
100.0
Didn't need it
Had no
coverage for it
Too expensive
Another reason
Missing
Don't know
Total
98
Information Insights, Inc.
Mat-Su Primary Healthcare Plan 2005-2015
29) In the past two years have you or someone in your household used
behavioral health care (mental health services, counseling, or substance
abuse treatment)?
Valid
Missing
Frequency
327
Percent
81.8
Yes
67
16.8
17.0
Total
394
98.5
100.0
Blank
2
.5
Don't know
4
1.0
Total
6
1.5
400
100.0
No
Total
Crosstabulation: Geographic
Group by Used Behavioral Health
Care
Upper Susitna
Count
% within
Geographic group
Glenn Highway
Count
% within
Geographic group
Core Tracts
Count
% within
Geographic group
Collar Tracts
Count
% within
Geographic group
Total
Count
% within
Geographic group
Information Insights, Inc.
Yes
Valid Percent
83.0
No
Cumulative
Percent
83.0
100.0
Total
6
43
49
12.2%
87.8%
100.0%
5
43
48
10.4%
89.6%
100.0%
17
107
124
13.7%
86.3%
100.0%
39
133
172
22.7%
77.3%
100.0%
67
326
393
17.0%
83.0%
100.0%
99
Mat-Su Primary Healthcare Plan 2005-2015
30) If no one in your household has used behavioral health care, was it
because you...
Valid
Didn't need it
Frequency
267
Percent
66.8
Valid Percent
97.1
Cumulative
Percent
97.1
1
.3
.4
97.5
Had no
coverage for it
Too expensive
2
.5
.7
98.2
5
1.3
1.8
100.0
Total
275
68.8
100.0
Blank
54
13.5
2
.5
69
17.3
Another reason
Missing
Don't know
Valid skip
Total
Total
125
31.3
400
100.0
31) In the past two years have you or someone in your household used
other health services (physical therapy, x-rays, prescription drugs, etc.)?
Valid
Missing
Frequency
61
Percent
15.3
Valid Percent
15.4
Cumulative
Percent
15.4
Yes
336
84.0
84.6
100.0
Total
397
99.3
100.0
Blank
3
.8
400
100.0
No
Total
Crosstabulation: Geographic Group
by Used Other Services
Upper Susitna
Count
% within Geographic
group
Glenn Highway
Count
% within Geographic
group
Core Tracts
Count
% within Geographic
group
Collar Tracts
Count
% within Geographic
group
Total
Count
% within Geographic
group
100
Yes
No
Total
34
16
50
68.0%
32.0%
100.0%
37
12
49
75.5%
24.5%
100.0%
112
12
124
90.3%
9.7%
100.0%
153
21
174
87.9%
12.1%
100.0%
336
61
397
84.6%
15.4%
100.0%
Information Insights, Inc.
Mat-Su Primary Healthcare Plan 2005-2015
32) If no one in your household has used other health services, was it
because you...
Valid
Missing
Didn't need it
Frequency
45
Percent
11.3
Valid Percent
90.0
Cumulative
Percent
90.0
1
.3
2.0
92.0
100.0
Too
expensive
Another
reason
Total
4
1.0
8.0
50
12.5
100.0
Blank
12
3.0
Don't know
1
.3
Valid skip
337
84.3
Total
350
87.5
400
100.0
Total
33) Have you or anyone in your household been diagnosed with cancer?
Valid
Missing
Valid Percent
87.6
Cumulative
Percent
87.6
12.3
12.4
100.0
98.8
100.0
Frequency
346
Percent
86.5
Yes
49
Total
395
Blank
4
1.0
Don't know
1
.3
No
Total
Total
5
1.3
400
100.0
34) Did you or are they receiving treatment for the cancer?
Valid
Missing
No
Frequency
15
Percent
3.8
Valid Percent
31.3
Cumulative
Percent
31.3
100.0
Yes
33
8.3
68.8
Total
48
12.0
100.0
Blank
5
1.3
Valid skip
347
86.8
Total
352
88.0
400
100.0
Total
Information Insights, Inc.
101
Mat-Su Primary Healthcare Plan 2005-2015
35) Have you or anyone in your household been diagnosed with heart
disease?
Valid
Missing
Frequency
351
Percent
87.8
Valid Percent
88.9
Cumulative
Percent
88.9
Yes
44
11.0
11.1
100.0
Total
395
98.8
100.0
Blank
4
1.0
Don't know
1
.3
Total
5
1.3
400
100.0
No
Total
36) Did you or are they receiving treatment for the heart disease?
Valid
Missing
Total
102
No
Frequency
7
Percent
1.8
Valid Percent
17.1
Cumulative
Percent
17.1
100.0
Yes
34
8.5
82.9
Total
41
10.3
100.0
Blank
7
1.8
Valid skip
352
88.0
Total
359
89.8
400
100.0
Information Insights, Inc.
Mat-Su Primary Healthcare Plan 2005-2015
37) Have you or anyone in your household been diagnosed with diabetes?
Valid
Missing
Valid Percent
86.6
Cumulative
Percent
86.6
13.3
13.4
100.0
98.8
100.0
Frequency
342
Percent
85.5
Yes
53
Total
395
Blank
4
1.0
Don't know
1
.3
No
Total
Total
5
1.3
400
100.0
38) Did you or are they receiving treatment for the diabetes?
Valid
Missing
Frequency
6
Percent
1.5
Valid Percent
11.5
Cumulative
Percent
11.5
Yes
46
11.5
88.5
100.0
Total
52
13.0
100.0
Blank
5
1.3
Valid skip
343
85.8
Total
348
87.0
400
100.0
No
Total
Information Insights, Inc.
103
Mat-Su Primary Healthcare Plan 2005-2015
39) Have you or anyone in your household been diagnosed with high blood
pressure?
Valid
Missing
Frequency
268
Percent
67.0
Valid Percent
67.8
Cumulative
Percent
67.8
Yes
127
31.8
32.2
100.0
Total
395
98.8
100.0
Blank
4
1.0
Don't know
1
.3
Total
5
1.3
400
100.0
No
Total
40) Did you or are they receiving treatment for the high blood pressure?
Valid
Missing
Total
104
Valid Percent
1.6
Cumulative
Percent
1.6
30.5
98.4
100.0
31.0
100.0
Frequency
2
Percent
.5
Yes
122
Total
124
No
Blank
6
1.5
Valid skip
270
67.5
Total
276
69.0
400
100.0
Information Insights, Inc.
Mat-Su Primary Healthcare Plan 2005-2015
41) Have you or anyone in your household been diagnosed with hepatitis
C?
Valid
No
Frequency
385
Percent
96.3
Valid Percent
97.7
Cumulative
Percent
97.7
100.0
Yes
Missing
9
2.3
2.3
Total
394
98.5
100.0
Blank
6
1.5
400
100.0
Total
42) Did you or are they receiving treatment for the hepatitis C?
Valid
Missing
Frequency
8
Percent
2.0
Valid Percent
72.7
Yes
3
.8
27.3
Total
11
2.8
100.0
No
Blank
4
1.0
Valid skip
385
96.3
Total
389
97.3
400
100.0
Total
Cumulative
Percent
72.7
100.0
43) How many times per week do you engage in exercise activities that
make you sweat and breath hard of at least 20 to 30 minutes in duration?
N
Valid
Missing
376
24
Mean
3.42
Median
3.00
Information Insights, Inc.
105
Mat-Su Primary Healthcare Plan 2005-2015
44) Are you or anyone in your household overweight?
Valid
Missing
Blank
5
1.3
4
1.0
9
2.3
400
100.0
Count
% within Geographic
group
Count
% within Geographic
group
Count
% within Geographic
group
Count
% within Geographic
group
106
100.0
100.0
391
% within Geographic
group
Total
56.3
97.8
220
Total
Crosstabulation: Geographic Group by
Overweight
Upper Susitna
Count
Collar Tracts
55.0
Yes
No
Total
Core Tracts
Cumulative
Percent
43.7
Percent
42.8
Don't
know/refused
Total
Glenn Highway
Valid Percent
43.7
Frequency
171
Yes
No
Total
24
26
50
48.0%
52.0%
100.0%
24
25
49
49.0%
51.0%
100.0%
71
50
121
58.7%
41.3%
100.0%
101
70
171
59.1%
40.9%
100.0%
220
171
391
56.3%
43.7%
100.0%
Information Insights, Inc.
Mat-Su Primary Healthcare Plan 2005-2015
45) What age group do you belong to?
Valid
Frequency
35
Percent
8.8
Valid Percent
8.9
Cumulative
Percent
8.9
30-39 years old
62
15.5
15.7
24.6
40-49 years old
110
27.5
27.9
52.5
50-59 years old
103
25.8
26.1
78.7
60-69 years old
48
12.0
12.2
90.9
36
9.0
9.1
100.0
394
98.5
100.0
6
1.5
400
100.0
18-29 years old
70 years old or
older
Total
Missing
Blank
Total
Crosstabulation: Geographic
Group by Age
Upper Susitna
Count
Glenn Highway
% within
Geographic
group
Count
Core Tracts
% within
Geographic
group
Count
Collar Tracts
% within
Geographic
group
Count
Total
% within
Geographic
group
Count
% within
Geographic
group
Information Insights, Inc.
Under 40
years old
5
40-59
years old
34
60 years old
or older
11
10.0%
68.0%
22.0%
100.0%
14
23
12
49
28.6%
46.9%
24.5%
100.0%
25
70
27
122
20.5%
57.4%
22.1%
100.0%
53
86
34
173
30.6%
49.7%
19.7%
100.0%
97
213
84
394
24.6%
54.1%
21.3%
100.0%
Total
50
107
Mat-Su Primary Healthcare Plan 2005-2015
46) What is the last level of education you completed?
Frequency
Valid
High school
diploma or GED
Some college
Undergraduate
degree
Graduate or
professional
degree
Other
Missing
Valid Percent
23.8
24.2
24.2
142
35.5
36.1
60.3
73
18.3
18.6
78.9
59
14.8
15.0
93.9
100.0
24
6.0
6.1
393
98.3
100.0
Blank
7
1.8
400
100.0
Crosstabulation: Geographic
Group by Level of Education
Upper Susitna
Count
Glenn Highway
% within
Geographic
group
Count
Core Tracts
% within
Geographic
group
Count
Collar Tracts
% within
Geographic
group
Count
Total
% within
Geographic
group
Count
% within
Geographic
group
Cumulative
Percent
95
Total
Total
108
Percent
Less than
undergraduate
degree
Undergrad or
graduate
degree
Other
Total
30
18
2
50
60.0%
36.0%
4.0%
100.0%
34
11
3
48
70.8%
22.9%
6.3%
100.0%
72
41
9
122
59.0%
33.6%
7.4%
100.0%
101
62
10
173
58.4%
35.8%
5.8%
100.0%
237
132
24
393
60.3%
33.6%
6.1%
100.0%
Information Insights, Inc.
Mat-Su Primary Healthcare Plan 2005-2015
47) What gender are you?
Valid
Missing
Valid Percent
36.0
Cumulative
Percent
36.0
63.0
64.0
100.0
98.5
100.0
Frequency
142
Percent
35.5
Female
252
Total
394
Male
Blank
Total
Information Insights, Inc.
6
1.5
400
100.0
109
Mat-Su Primary Healthcare Plan 2005-2015
48) From the list I'll read, which range includes your household's income?
Frequency
Valid
Missing
Less than
$15,000
$15,001 to
$25,000
$25,001 to
$40,000
$40,001 to
$60,000
$60,001 to
$80,000
$80,001 to
$100,000
$100,001 or
more
Total
8.3
8.3
30
7.5
8.6
16.9
66
16.5
18.9
35.8
73
18.3
20.9
56.7
61
15.3
17.5
74.2
51
12.8
14.6
88.8
39
9.8
11.2
100.0
100.0
87.3
14
3.5
Don't know
37
9.3
Total
51
12.8
400
100.0
Glenn Highway
% within
Geographic
group
Count
Core Tracts
% within
Geographic
group
Count
Collar Tracts
% within
Geographic
group
Count
Total
% within
Geographic
group
Count
% within
Geographic
group
Cumulative
Percent
7.3
349
Crosstabulation: Geographic
Group by Household Income
Upper Susitna
Count
Valid Percent
29
Blank
Total
110
Percent
Less than
$40,000
25
$40,000 to
$80,000
19
54.3%
More than
$80,000
Total
2
46
41.3%
4.3%
100.0%
11
22
12
45
24.4%
48.9%
26.7%
100.0%
41
35
33
109
37.6%
32.1%
30.3%
100.0%
48
58
43
149
32.2%
38.9%
28.9%
100.0%
125
134
90
349
35.8%
38.4%
25.8%
100.0%
Information Insights, Inc.
Mat-Su Primary Healthcare Plan 2005-2015
APPENDIX D: HOUSEHOLD SURVEY QUESTIONNAIRRE
Hi, my name is _____ and I’m conducting a short survey about health care needs in the
Mat-Su. I’m not selling anything. I’d just like to get your experiences related to health
care. This information is being collected for a local health care planning group trying to
improve health care in the Valley. By participating you will be entered in a drawing to
win $200. Do you have 10 minutes to answer our questions?
Great, thank you. If you have no opinion or don’t know for some of these questions, I’d
like to know that as well.
1) Are you 18 years of age or older?
Yes
No (ask to speak to an adult and
repeat intro, if no adult is available
thank them and hang up)
2) How long have you lived in the MatSu area?
Less than one year
1-2 years
3-5 years
6-10 years
11-19 years
20 years or more
3) How far do you live from the
Palmer/Wasilla area?
Live in Palmer/Wasilla area
Less than 5 miles
6-10 miles
11-15 miles
16-20 miles
21-40 miles
41-70 miles
71-100 miles
Don’t know
4) How frequently do you travel to the
Palmer/Wasilla area?
Live in Palmer/Wasilla area
Less than once a month
Once a month
Twice a month
1-2 times a week
3-4 times a week
5 times a week
Every day
Don’t know
5) Do you or someone in your household
have reliable transportation?
Yes (skip to #7)
No
Don’t know
6) If no, do you or someone in your
household lack a…
Reliable vehicle
Valid driver’s license
Both
Other_____________
N/A (have reliable
transportation)
7) How many adults live in your
household including yourself?
1 (just respondent)
2
3-4
5-6
7 or more adults
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Mat-Su Primary Healthcare Plan 2005-2015
8) How many children (under 18 years
old) live in your household?
0
1
2
3-4
5 or more children
9) In what geographic area do you and
members of your household typically
obtain your primary physical health
care? (check all that apply)
Palmer/Wasilla area (skip to #11)
Other area of Mat-Su (skip to #11)
Anchorage
Another location _____________
Don’t use health care
(skip to #11)
Don’t know (skip to #11)
10) What is the main reason you or
members of your household leave MatSu for primary physical health care
(check all that apply)
Must for coverage (VA, etc.)
Convenience—already somewhere
else on a regular basis
Think higher quality/more skilled
providers elsewhere
Closest providers not in Mat-Su
Another reason________________
Don’t know
11) In what geographic area do you and
members of your household typically
obtain your specialist physical health
care? (check all that apply)
Palmer/Wasilla area (skip to #13)
Other area of Mat-Su (skip to #13)
Anchorage
Another location _____________
Don’t use health care
(skip to #13)
Don’t know (skip to #13)
112 | Information Insights, Inc.
12) What is the main reason you or
members of your household leave MatSu for specialist physical health care
(check all that apply)
Must for coverage (VA, etc.)
Convenience—already somewhere
else on a regular basis
Think higher quality/more skilled
providers elsewhere
Closest providers not in Mat-Su
Another reason________________
Don’t know
13) In what geographic area do you and
members of your household typically
obtain your dental care? (check all that
apply)
Palmer/Wasilla area (skip to #15)
Other area of Mat-Su (skip to #15)
Anchorage
Another location ______________
Don’t use health care
(skip to #15)
Don’t know (skip to #15)
14) What is the main reason you or
members of your household leave MatSu for dental care (check all that apply)
Must for coverage (VA, etc.)
Convenience—already somewhere
else on a regular basis
Think higher quality/more skilled
providers elsewhere
Closest providers not in Mat-Su
Another reason________________
Don’t know
Mat-Su Primary Healthcare Plan 2005-2015
15) In what geographic area do you and
members of your household typically
obtain your behavioral health care
(mental health services, counseling, or
substance abuse treatment)? (check all
that apply)
Palmer/Wasilla area (skip to #17)
Other area of Mat-Su (skip to #17)
Anchorage
Another location _____________
Don’t use health care
(skip to #17)
Don’t know (skip to #17)
18) What is the main reason you or
members of your household leave MatSu for other health services (physical
therapy, x-rays, prescription drugs, etc.)?
(check all that apply)
Must for coverage (VA, etc.)
Convenience—already somewhere
else on a regular basis
Think higher quality/more skilled
providers elsewhere
Closest providers not in Mat-Su
Another reason________________
Don’t know
16) What is the main reason you or
members of your household leave MatSu for behavioral health care (mental
health services, counseling, or substance
abuse treatment)? (check all that apply)
Must for coverage (VA, etc.)
Convenience—already somewhere
else on a regular basis
Think higher quality/more skilled
providers elsewhere
Closest providers not in Mat-Su
Another reason________________
Don’t know
19) Do you and members of your
household anticipate using the new
Valley Hospital once it opens?
Yes
No
Don’t know
17) In what geographic area do you and
members of your household typically
obtain your other health services
(physical therapy, x-rays, prescription
drugs, etc.)? (check all that apply)
Palmer/Wasilla area (skip to #19)
Other area of Mat-Su (skip to #19)
Anchorage
Another location _____________
Don’t use health care
(skip to #19)
Don’t know (skip to #19)
Information Insights, Inc.
20) Do you and members of your
household have public or private health
coverage?
Yes
No (skip to #22)
Some yes, some no
Don’t know
21) If yes, what type of health coverage
do you and members of your household
have? (pick as many as applicable)
Private (Blue Cross, Aetna, etc.)
Private (catastrophic/major med only)
Medicare
Medicaid
Veterans’ Administration
Denali Kid Care
Native Health Service
Workers’ Compensation
Other_______________
Don’t know
Skip to #23
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Mat-Su Primary Healthcare Plan 2005-2015
22) What is the primary reason you
and/or members of your household do
not have insurance?
Cannot afford
Don’t qualify for government
programs
Don’t want or need
Other______________
Don’t know
23) In the past two years have you or
someone in your household used
primary physical health care (including
routine preventative examinations)?
Yes (skip to #25)
No
Don’t know
24) If no one in your household has used
primary physical health care (including
routine preventative examinations) was
it because you…
Didn’t need it
Had no coverage for it
Too expensive
Another reason______________
Don’t know
25) In the past two years have you or
someone in your household used
specialist physical health care?
Yes (skip to #27)
No
Don’t know
26) If no one in your household has used
specialist physical health care was it
because you…
Didn’t need it
Had no coverage for it
Too expensive
Another reason_______________
Don’t know
114 | Information Insights, Inc.
27) In the past two years have you or
someone in your household used dental
health care?
Yes (skip to #29)
No
Don’t know
28) If no one in your household has used
dental health care was it because you…
Didn’t need it
Had no coverage for it
Too expensive
Another reason__________
Don’t know
29) In the past two years have you or
someone in your household used
behavioral health care (mental health
services, counseling, or substance abuse
treatment)?
Yes (skip to #31)
No
Don’t know
30) If no one in your household has used
behavioral health care (mental health
services, counseling, or substance abuse
treatment) was it because you…
Didn’t need it
Had no coverage for it
Too expensive
Another reason__________
Don’t know
31) In the past two years have you or
someone in your household used other
health services (physical therapy, x-rays,
prescription drugs, etc.)?
Yes (skip to #33)
No
Don’t know
Mat-Su Primary Healthcare Plan 2005-2015
32) If no one in your household has used
other health services (physical therapy,
x-rays, prescription drugs, etc.) was it
because you…
Didn’t need it
Had no coverage for it
Too expensive
Another reason_______________
Don’t know
33) Have you or anyone in your
household been diagnosed with cancer?
Yes
No (skip to #35)
Don’t know
34) Did you or are they receiving
treatment for the cancer?
Yes
No
Don’t know
35) Have you or anyone in your
household been diagnosed with heart
disease?
Yes
No (skip to #37)
Don’t know
36) Did you or are they receiving
treatment for the heart disease?
Yes
No
Don’t know
37) Have you or anyone in your
household been diagnosed with
diabetes?
Yes
No (skip to #39)
Don’t know
38) Did you or are they receiving
treatment for the diabetes?
Yes
No
Don’t know
39) Have you or anyone in your
household been diagnosed with high
blood pressure?
Yes
No (skip to #41)
Don’t know
40) Did you or are they receiving
treatment for the high blood pressure?
Yes
No
Don’t know
41) Have you or anyone in your
household been diagnosed with hepatitis
C?
Yes
No (skip to #43)
Don’t know
42) Did you or are they receiving
treatment for the hepatitis C?
Yes
No
Don’t know
43) How many times per week do you
engage in exercise activities that make
you sweat and breath hard such as
cycling, swimming, dancing, jogging,
active sports or brisk walking of at least
20 to 30 minutes duration?
_____________________
Don’t know
44) Are you or anyone in your
household overweight?
Yes
No
Don’t know/refused
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Mat-Su Primary Healthcare Plan 2005-2015
We have just a few questions for
classification purposes.
45) What age group do you belong to?
18-29 years old
30-39 years old
40-49 years old
50-59 years old
60-69 years old
70 years old or older
46) What is the last level of education
you completed?
High school diploma or GED
Some college
Undergraduate degree
Graduate or professional degree
Other_______________
47) What gender are you?
Male
Female
48) From the list I’ll read, which range
includes your household’s income?
Less than $15,000
$15,001 to $25,000
$25,001 to $40,000
$40,001 to $60,000
$60,001 to $80,000
$80,001 to $100,000
$100,001 or more
Don’t know
Those are all of the questions; thank you so much for your time. Now if I can get your
name and a telephone number where you can be reached if you win the drawing.
First Name______________________________
Telephone Number_______________________
If you would like more information about the Mat-Su Rural Health Care Network,
please visit our web site at http://healthnetwork.infoinsights.com or e-mail Sylvan Robb
at [email protected].
116 | Information Insights, Inc.